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retain all rights to their work. No part of this publication may be reproduced in any form
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Virginia Policy Review and its contributors. Nothing in this publication represents the ideas,
beliefs, or positions of the Virginia Policy Review, its staff, or the Frank Batten School of
Leadership and Public Policy. All statements are strictly the ideas, beliefs, or positions of the
authors.

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Volume VII

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Issue II

A student-run journal of:

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Winter 2014

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From the Editors
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Dear Reader,
With historically low approval ratings, what reforms should Congress enact to restore public
confidence? In the wake of several pay-for-play scandals, is it time for the NCAA to abandon its
long-standing amateurism policy? How do K-12 students internalize parental expectations, and
how can schools better identify students with high potential earlier? What do congressional debtreduction proposals mean for cancer patients who rely on Medicaid and Medicare? What role, if
any, should covert action play in U.S. foreign policy, and how do the perceptions of covert action
differ from reality?
Welcome to the 2014 Winter Issue of our Virginia Policy Review. In the following pages, we
explore these questions and many others, bringing critical perspectives to the contentious policy
debates of our time.
The problems we tackle—education, congressional upheaval, and the struggle between individual
rights and collective security—are nothing new. Yet too often we focus on the problems rather
than the solutions. In an open letter from the Frank Batten School of Leadership and Public
Policy’s graduate class of 2014, UVA’s Master of Public Policy students recommend reforms to
break congressional gridlock. Additionally, our articles rely on unique perspectives from
stakeholders. In an intriguing back-and-forth, two Division I student-athletes discuss the merits of
the NCAA amateurism policies, which currently ban them from receiving payments or
monetizing their own likeness. This edition also features original research by two Batten MPP
students who use national survey data to explore trends in contemporary K-12 education.
In keeping with our mission of printing the best work of UVA MPP’s alongside that of other
prominent voices in the policy debate, our Winter Issue features significant contributions from
outside the Frank Batten School of Leadership and Public Policy. The Virginia Policy Review is
especially pleased to include the work of the University of Georgia’s widely published Regents
Professor of Public Science, Loch K. Johnson, whose contribution dispels a number of
misconceptions surrounding covert action.
The 2014 Winter Issue considers broad-ranging policy topics, from congressional reform efforts,
to NCAA policy, to identifying high achievers early in a public school setting. Across this range,
we hope that each article offers practical solutions and not simply analyses of the problems
themselves. Policy change can be made, and policy students can drive change.
Very Sincerely,
The Editorial Board of the Virginia Policy Review

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Staff Acknowledgements
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Co-Editors-in-Chief:

Benjamin W. Lynch
Caitlin Cummings

Managing Editor:

Victoria Catanese

Executive Director:

Frank Bontempo

Content Director:

Kyle Schnoebelen

Senior Editors:

Rebecca Beeson
Alex Dumitriu
Christopher Palmer

Director of Outreach:

Malcolm McGregor

Director of Events:

Yuhuan Fu

Associate Editors:
Minahil Amin

Topher Lancaster

Michael Bock

Baylee Molloy

Graham Egan

Zachary Porter

Sama Ehtesham

Elsa Schultze

Yuwa Ikhinmwin
Associated Editors of The Third Rail:
Anna Barber

Joseph Liss

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We welcome your thoughts. Please forward any comments, questions, or concerns to
virginiapolicyreview@gmail.com or visit us online at www.virginiapolicyreview.com.

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Table of Contents
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I. An Open Letter to Congress
Elizabeth Brightwell, MPP Candidate at the University of Virginia
Jordan Minot, MPP Candidate at the University of Virginia

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II. The Value of an Education
Anonymous NCAA Division I Athlete

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III. Give Athletes Their Name Back
Chris Foley, MPP Candidate at the University of Virginia

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IV. Impact of Parental Expectations on Education and Employment Outcome
Christine Oâ&#x20AC;&#x2122;Donnell, MPP Candidate at the University of Virginia

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V. Early Identification of High-Achieving, Low-income Students and
Their College Participation Rates
Lena Shi, MPP Candidate at the University of Virginia

VII. The Debt Reform Proposals and the Potential Impact of Implementation
on Medicare, Medicaid, and Cancer Patients
Sarah Thompson Schick, JD Candidate at the University of Virginia

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VIII. Myths of Covert Action
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Loch Johnson, Regents Professor of Political Science at the University of Georgia

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An Open Letter to Congress
Elizabeth Brightwell
Jordan Minot
It is no secret that the 113th Congress is both unproductive in terms of passing legislation and
historically unpopular, with approval ratings hovering around ten percent. Nonetheless, for a
group of individuals preparing for careers in public policy, September through December 2013
proved a fascinating time to explore the challenges facing Congress. Our focus has been timely—
since the start of our course, we have seen a crisis in Syria stir up discussions over war powers,
spoken to Senators and House Representatives amidst the 16-day government shutdown, and
witnessed a historic change of Senate filibuster rules governing the majority of judicial
nominations.
Through our analysis, we have prepared a set of reform proposals that we believe would improve
the effectiveness of both Virginia’s delegation and of the legislature as a whole. We recognize the
difficulty of changing entrenched procedures and traditions, but in light of record low levels of
public confidence in the legislative branch, we hope that due consideration will be given to the
following proposals.
We have divided our proposals into two basic categories: reforms that will require changes to the
Constitution and are focused on the electoral process, and those that can be completed entirely
within Congress via rule changes and are focused on increasing collaboration.
Constitutional Reforms
The first of our proposed constitutional reforms is a new process for redistricting. Article I of
the Constitution charges that “Representatives… shall be apportioned to the several
states…according to their respective numbers.” The document, however, does not prescribe a
method by which the states should delineate the areas of each congressional district. The history
of redistricting is fraught with racial injustice, and the practice of gerrymandering with the goal of
creating safer districts for parties in control of state legislatures is more persistent than ever.
Often, this party-based redistricting process is cited as a contributing factor towards an
incumbency reelection rate of 90 percent and increased levels of partisanship.
The drafters of the Bill of Rights comprehended a need for greater constitutional controls on
redistricting. The Congressional Apportionment Amendment, the first proposed amendment to
the Constitution, would have set maximums and minimums for Congressional district populations
in the interest of equal representation. Although the amendment was never ratified, the authors’
concern seems prescient today. With modern geographic information systems (GIS) and other
previously unavailable sources of data, we could readily create districts that not only contain
numerically equivalent populations, but that also reflect the racial, socioeconomic, and urban
characteristics of each state. By placing constitutional guidance on states, we would lay the
groundwork for a more level playing field in Congressional elections and hopefully shape a
legislature whose ideology more accurately reflects that of the geographic pieces composing it.
Our second proposed constitutional reform would address campaign finance and limit
campaign contributions from so-called Super PACS. The Supreme Court decision in Citizens

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United v. Federal Election Commission has driven the tidal wave of money in politics and,
consequently, expanded concern over the fundamental fairness of our elections. The revenue
streams, like redistricting, tend to favor incumbents, making established members harder to
displace. By limiting the amount of money that can be collected and spent, not just by the
candidates, but by issue groups as well, we believe members may devote less time to fundraising
and be in less danger of becoming beholden to their campaign contributors.
Establishing term limits were a popular topic of discussion with our group, but we ultimately
decided that electoral fairness would be more effectively achieved with the above measures. In
the presence of elections that do not favor incumbents as heavily, term limits would unnecessarily
limit the democratic choice of voters to re-elect representatives who have served their districts
well. Term limits would also contribute to higher turnover and could create a lack of institutional
knowledge among representatives, ceding additional influence to lobbying organizations. Such is
the case in California, where voters have imposed strict term limits for state office.
Congressional Rule Reforms
Constitutional change is difficult by design. In light of this reality, there are a number of
productive reforms that could be completed entirely within Congress by statute or simple
majoritarian rule changes. Specifically, we propose three bipartisan collaboration initiatives:
banning live streaming of activities in Congressional committee chambers, lifting the ban on
earmarks, and further reforming the filibuster.
A bipartisan collaboration initiative could take any number of forms. However, the goal is to
promote member interaction on a personal level. Collaboration could range from random
assignment to visit another memberâ&#x20AC;&#x2122;s district to simply sharing a meal with another member.
Although this may seem trivial, social psychology research suggests that individuals who
cooperate on relatively unimportant matters are less likely to hold grudges over disagreements,
and far more likely to cooperate when consequential issues arise.
Beyond simply fostering good relationships, we want to encourage members to collaborate
without facing partisan and public repercussions for their every word. Televised committee
hearings and markups have transformed forums for substantive policy debate into stages for
political grandstanding. The presence of cameras has forced members to focus on the political
implications of their statements instead of speaking candidly. Eliminating televised recordings
would allow members to freely discuss ideas, forge deals, and take potentially unpopular stances,
ultimately improving the quality of each committeeâ&#x20AC;&#x2122;s policy decisions. We believe the potential
gain in the quality of deliberation at the committee level is worth the tradeoff in transparency.
Members would not be limited in their ability to make their positions known through the press
and statements made on the floor of each chamber.
To further encourage collaboration, we propose lifting the current ban on earmarks. Though often
attacked as wasteful, earmarks represented only a miniscule portion of actual government
spending. More importantly, they gave members the bargaining chips necessary to build
coalitions for substantive legislation. The current ban is well intentioned, but has created an
environment in which a member may wish to support a big-picture proposal, but cannot risk the
anger of his constituents (or party) in a primary contest if he cannot promise local benefit in
return. The concurring ban on earmarks and string of unproductive legislative sessions suggests

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that earmarks remain necessary given the political realities of passing contentious legislation.
Furthermore, a ban on Congressional earmarks often has the effect of delegating targeted
appropriations to the executive branch rather than eliminating them. Targeted appropriations still
exist; they are just distributed less democratically. The Constitution clearly vests spending power
and responsibility in the legislature, which is better suited to the appropriations function than
executive agencies.
Finally, we propose two significant changes to the Senate filibuster process. Recently, the
majority party in the Senate limited the filibusterâ&#x20AC;&#x2122;s use during most judicial confirmations,
reducing the number of votes needed for cloture from 60 votes to a simple majority. We
recommend this change be undone, restoring the 60-Senator majority required for cloture
regarding affected judicial nominations. However, we also recommend eliminating the practice of
placing secret holds on legislation and requiring that members speak on the floor for the entirety
of the filibuster. This would preserve the traditional check on majoritarian rule while ensuring
that those holding up votes have to actually stand up for their convictions.
Congress has always been an evolving body, and leaders have altered the institution on the party,
committee, and chamber levels in innumerable ways. The scope of our proposed reforms is
admittedly significant. However, faced with unprecedented levels of partisanship and gridlock,
these reforms would contribute to a fairer electoral process as well as remove obstacles to
completing the efficient legislative work that Americans deserve and expect from their
representatives. !
This letter combines the collective recommendations from a graduate course on the functioning of
the U.S. Congress. The recommendations were developed during a conversation that drew on
both formal academic experience and direct interactions with Representatives and Senators.
These recommendations have been respectfully presented to the Virginia Congressional
Delegation.

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The Value of an Education
Anonymous NCAA Division I Athlete
The names are well known and the scandals commonplace. Johnny Manziel, Arian Foster, D.J.
Fluker – college athletes with impressive athletic resumes taking money under the table and
engaging in “violations of NCAA code.” Manziel was paid for his autograph, Fluker accepted
money from a middleman to an agent, and Foster has admitted to accepting money under the
table during his football career at the University of Tennessee. As these young men are attacked
for playing “outside the rules,” much of the commentary on college athletes centers around the
same, tired questions: How could they do such a thing? Why would they participate in something
so idiotic? A better question would be: what circumstances incentivize promising young athletes
to behave this way?
The National Collegiate Athletic Association (NCAA) mandates the maximum number of
scholarships allocated to each collegiate sport. For “head-count sports,” a full scholarship is
usually guaranteed for up to 63 or 85 football players, depending on the football division, and up
to 13 players for basketball teams. For “equivalency sports,” the number of scholarships a
university can provide is limited, and it is left to the coach to decide how to divide these
scholarships amongst players. This means for a sport like baseball, which is given 11.7
scholarships, not even close to every player will get the mythical “tuition, room and board”
experience so heavily cited in anti-pay-for-play arguments.
The average full scholarship, which pays for tuition, housing, and food, is valued at about
$23,204.1 But that isn’t enough to cover the inevitable, out-of-pocket expenses that a normal
college student has, including clothes, transportation, food, and the occasional outing with
friends. Some low-income students are eligible for Pell Grants, a need-based federal grant
program. Additionally, the Student-Athlete Opportunity Fund exists to cover a small portion of
out-of-pocket expenses incurred. But even these options leave many athletes struggling to pay
their bills. When these options run out, where else can athletes turn?
The NCAA allots 20 hours a week for in-season sports to practice. But with strength training,
film review, and “voluntary” training sessions, studies show that the average Division I athlete
actually dedicates about 40 hours a week to athletic endeavors.2 During the course of a normal
day, athletes are expected to attend lifting weights, class, practice, a mandatory study hall, and
perhaps an evening film session. While a regular student can find a part-time job to help with
expenses, it is nearly impossible for a student-athlete to do the same. They already have a 40-hour
a week job— their sport. The difference? This job doesn’t pay. College athletes work 40-hour

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1

Ramogi Huma and Ellen J. Staurowsky, “The $6 Billion Heist: Robbing College Athletes Under the
Guise of Amateurism,” National College Players Association (2012).
2
Lynn O’Shaughnessy, “Do College Athletes Have Time to Be Students?” CBS News, February 18, 2011,
accessed February 19, 2014, http://www.cbsnews.com/news/do-college-athletes-have-time-to-be-students/.

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weeks to succeed in a billion dollar industry from which they gain zero profit. Meanwhile, a male
college basketball player has an estimated worth of about $289,031 to his university.3
But where will the money to support these athletes come from? While only ten percent of college
athletics programs earn enough money to pay all of their own expenses, the other 90 percent of
institutions are far from bankrupt.4 The average university athletic director salary is around
$500,000. The average assistant football coach makes $200,000 a year.5 Colleges and universities
generate over $12 billion in revenue from their sports teams. In 2013, the president of the NCAA
was paid over $1 million dollars. The money is there; it just isn’t allocated fairly. It is time to
reward those who are generating the revenue with their efforts on the field and the court.
Expenditures on coaching and administrative salaries and million-dollar facilities will have to be
reevaluated in order to compensate the athletes who are breaking their backs to make college
sports viable.
Opponents of paying athletes often make the argument that athletes are receiving a “free
education,” worth much more in future benefits than the dollar value of a scholarship. However,
there is a significant difference between receiving a free education and receiving a good
education while representing their schools on the field and on the court.
Student athletes must maintain a specific GPA and number of course hours in order to maintain
their eligibility. However, given the purely token emphasis on coursework, most student athletes
do not receive the education they were promised. In a recent study of UNC athletes, 60 percent of
football or basketball players from 2004 to 2012 were reading between a fourth and eighth grade
level. 6 What is the value of an education where, rather than being challenged, players are
encouraged to enroll in “gut,” or overly easy, classes in order to stay eligible to play? What
exactly are we teaching the three men’s basketball teams, who missed the first day of classes for
televised competitions?7
The lesson cannot be the tired and hollow mantra that “a student-athlete’s education is
important.” In the current climate, the most beneficial path for a successful athlete is to enter the
draft as quickly as possible. At least by playing professionally, some of the sports industry’s
profit might end up back in the athlete’s pockets. And the more underclassmen that enter the
draft, the faster important, entertaining, and revenue-generating talent leaves the college pool.

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It goes without saying that college athletes have cause for gratitude. The opportunity to play the
sport they love while getting a college education is substantial. But at a time when college sports
are clearly a profitable industry, and athletes are subjected to increased media exposure, being a
college athlete is equivalent to being a student with a full time job paying their way through
schoolâ&#x20AC;&#x201D;only minus the paycheck. 8 Providing monetary compensation sufficient to cover
expenses while athletes are still in school would allow student athletes to continue to compete at
the college level while also completing a meaningful, not token, education. !

Give Athletes Their Names Back
Chris Foley
Johnny Manziel, quarterback at Texas A&M since 2012, could have quoted John Proctor from
The Crucible in the wake of last summer’s autograph scandal: “I have given you my soul; leave
me my name!” Manziel’s case sparked increased scrutiny of the NCAA’s amateurism policy,
which not only prohibits paying student-athletes, but also bars them from profiting off of their
own names through the sale of autographs or endorsements.
Despite high profile cases like Manziel’s, the majority of student-athletes are more than
sufficiently compensated in terms of scholarships, athletic gear, and other perks. So, should all
student athletes receive further compensation in the form of payment from their University?
Absolutely not. Should a select few be allowed to profit off of their own names? Absolutely. Only
superstar athletes provide more value to their university and the NCAA than they receive.
Allowing players to sell autographs and receive a percentage of royalties on jersey sales would
create a market solution to address the inequality of NCAA’s current amateurism policies.
Essentially, student athletes who create excess value should be permitted to profit directly while
not being paid salaries by their universities.
Very few NCAA athletes have the marketability to profit off their own name. I am a Division I
NCAA athlete who, like most, has benefitted enormously at the expense of my university and the
NCAA. A full athletic scholarship covers tuition, books, housing, and a meal plan. I also received
practice and competition gear, which the University of Virginia also washes for me, and an
allowance of $250/semester to spend on casual clothes. I get priority registration for classes and
access to an athlete-only dining hall. At no cost to myself, I have traveled to cities including
Seattle, San Francisco, and Boston for competitions. Similar descriptions would apply to almost
every college athlete. They receive incredible benefits in exchange for playing the sport they love.
NCAA amateurism is an entrenched notion aimed at maintaining the purity of sport. The policies
surrounding this ideal are reasonable for almost every athlete in the NCAA. However, for elite
football and basketball teams, which at times resemble more of a business than a part-time
competition, this policy is laughable. Top college football and basketball programs rake in
millions of dollars annually; the value top players provide their school and the NCAA far exceeds
the value of a full scholarship. The college football and basketball industry has exploded in recent
years. Last year there were 76 Division I football coaches earning at least $1 million. Legendary
Alabama coach Nick Saban tops the list at $5.65 million. In 2013, UVA paid Mike London $2.6
million to lead the Cavaliers to a 2-10 season. Colleges and universities believe these coaches
provide value and pay them accordingly. Athletic departments clearly have no problem paying for
on-field success. Except in the case of actual athletes.
Athletic programs in major conferences also receive millions of dollars in television broadcasting
contracts. According to ESPN, schools in the largest conferences—the ACC, Big Ten, Big12,
PAC-12, and SEC—currently receive between $200 and $250 million from their conference
television deals. This television revenue is driven in large part by fans who want to see star
athletes play. The result is that athletes with celebrity status, like Manziel, create huge profits for
the NCAA and their respective universities, but make nothing themselves.

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Jersey sales are an even more concrete example of the NCAA exploiting the popularity of its
well-known athletes. The organization’s flimsy dodge is that jerseys do not represent specific
individuals because they do not have specific names on the back. Sportswriter Jay Bilas recently
used the NCAA’s own website to debunk this argument. A search of “Johnny Manziel” returned
Texas A&M #2 (Manziel’s number) jerseys in several colors, sales of which are obviously driven
by Manziel being the star quarterback. Giving players a percentage of profits from the sale of
their own jersey seems natural. If a school does not want to share profits, they could sell jerseys
with no number or a generic #1.
The NCAA’s blanket amateurism policies need to adapt to the realities of present-day college
football and basketball. Athletes like Johnny Manziel are worth far more than the benefits
afforded to the average student-athlete. Allowing athletes to sell autographs and earn royalties off
of jersey sales and endorsements would address some of the inequity of a system in which
millions of dollars are generated from the likeness of individuals who can’t sell their own
autograph for fifty bucks. Relaxing this part of the amateurism policy would allow a free market
of jersey and autograph sales to determine a player’s value. College athletes don’t need salaries.
Just give them back their names. !
Chris Foley is a current student-athlete at the University of Virginia, competing for the Cross
Country and Track and Field teams. He graduated last May with a B.A. in Economics and is now
a first year post-graduate at the Frank Batten School of Leadership and Public Policy.

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Impact of Parental Expectations on Education and
Employment Outcomes
Christine O’Donnell
Parents and their expectations play a major role in their child's development. Previous research
has shown that supportive parents who are involved in a child's education can help improve their
child's educational achievement. In this study, data from the National Longitudinal Survey of
Youth 1997 (NLSY97), a nationally representative samples of youths who were 12-16 years old as
of December 31, 1996 and re-surveyed on an annual basis, is used to assess the impact of
parental expectation on education and employment outcomes. Specifically, regression adjustment
is used to look at the effects of both positive expectations (e.g., chance of the child having a high
school diploma by age 20) and negative expectations (e.g., chance of the child being in jail by
age 20) on a range of outcomes including whether the child is employed and/or enrolled in
school, highest grade completed, and income (if employed). There are statistically significant
correlations between positive expectations and better outcomes as well as between negative
expectations and worse outcomes. Additionally, while there are statistically significant
differences between the expectations of parents from a racial minority or low-income family and
other parents, there are no differences in the effect of expectations across subgroups. The paper
concludes with a discussion of policies that could address low parental expectations and how to
help all children succeed.
Introduction
Many studies have found that parental expectations play a critical role in a child's academic and
future success.1 High expectations are correlated with an increased chance of children staying in
school and doing well.2 Furthermore, high parental expectations can compensate for teacher
expectations on student achievement.3 Most of the older studies focus on European Americans,
but some studies do analyze minority and low-income groups. They find that low-income,
African American, and Hispanic parents tend to have lower expectations than Asian American
parents.4 Additionally, some of these studies find that parental expectations impact students

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1

Pamela E. Davis-Kean, “The Influence of Parent Education and Family Income on Child Achievement:
The Indirect Role of Parental Expectations and the Home Environment,” Journal of Family Psychology 19,
no. 2 (2005): 294–304; Thomas P. Vartanian, David Karen, Page Walker Buck, and Wendy Cadge, “Early
Factors Leading to College Graduation for Asians and Non-Asians in the United States,” The Sociological
Quarterly 48 (2007): 165–197.
2
Don Hossler and Frances K. Stage, “Family and High School Experience Influences on the PostSecondary Education Plans of Ninth-Grade Students,” American Educational Research Journal 29, no. 2
(1992): 425–45; Samuel S. Peng and DeeAnn Wright, “Explanation Of Academic Achievement of Asian
American Students,” The Journal of Educational Research 87, no. 6 (1994): 346–352.
3
Aprile D. Benner and Rashmita S. Mistry, “Congruence of Mother and Teacher Education Expectations
and Low-Income Youth’s Academic Competence,” Journal of Educational Psychology 99 no. 1 (2007):
140–153.
4
Davis-Kean, 2005; Richard R. Pearce, “Eﬀects Of Cultural and Social Structural Factors on the
Achievement of White and Chinese American Students at School Transition Points,” American Education
Research Journal 43, no. 1 (2006): 75–101; Peng and Wright, 1994; Vartanian et al, 2007.

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differently between these subgroups. For example, Vartanian et al. finds that expectations have a
weaker impact on Asian Americans than on non-Asians. 5 Lastly, the majority of these studies
were done with cross-sectional and not longitudinal data sets.
Yamamoto and Holloway attempt to explain these differences in effects across subgroups by
looking into how expectations affect children and their learning environment. 6 They find several
things that predict parental expectations including:
1. Parents' belief that their child's effort determines their school performance rather than
other factors,
2. Parents' understanding of the school system and trust of its feedback, and
3. Parents' belief in their ability to affect their child's outcomes.
Thus, they suggest that low parental expectations may not be a reflection of the child's ability, but
of the parents' lack of understanding of the school system. If this is the case and expectations do
affect outcomes, then this analysis could suggest that additional policy intervention is needed to
involve parents in their child's education. It could increase the parent's understanding of the
system and efficacy, leading to higher expectations and hopefully better outcomes for the child.
In addition, Yamamoto and Holloway examine the ways in which parental expectations affect
student achievement. 7 High expectations might indicate that parents value achievement, and this
value could put pressure on children to perform well. High expectations could also create a selffulfilling prophecy, boosting student's own expectations about their ability and thus motivating
them to do well.
Additionally, high expectations could foster parental involvement in their child's education, and
several past studies have found a correlation between involvement and outcomes.8 If teachers are
aware of expectations, it could incentivize teachers to spend more time on students from families
with high expectations because they expect more from these students. Overall, if there are
differences in the effect of parental expectations between subgroups, it could suggest that
expectations are internalized in different ways.
Data Analysis
Source
The data used in this study is from the National Longitudinal Survey of Youth 1997 (NLSY97)
from the Bureau of Labor Statistics. The first round of the survey took place in 1997 and included
approximately 9,000 youths who were 12 to 16 years old as of December 31, 1996. During the
first round, both the youth and one of that youth's parents received hour-long interviews. Youths

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have continued to be interviewed on an annual basis; the most recent interview data available is
from 2011.
Parental expectations of long-term outcomes were included in the first round interviews. Parents
were asked to gauge the probability that a child would obtain a high school diploma by age 20,
obtain a college degree by age 30, be employed by age 30, be in jail by age 20, and be a parent by
age 20. The first three expectations are hereafter grouped as “positive expectations” (as they
describe the parent's expectation of success), whereas the last two expectations are hereafter
grouped as “negative expectations.”
From the most recent round of interviews in 2011, data about participants' long-term outcomes is
available. The 2011 interview asked about whether a participant received income in the past year,
and if they did, what their income was. The interviewers also asked whether participants were
enrolled in school in 2011.
Figure 1 plots the distributions of the various independent variables.

Distribution of the parent’s assessment of the likelihood that a child would obtain a high
school diploma by 20 (left) and the likelihood that a child would obtain a college diploma by
30 (right).

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Distribution of the parentâ&#x20AC;&#x2122;s assessment of the likelihood that a child would work 20 hours per
week (i.e. a usual work week) by 30 (left) and the distribution of the simple average of positive
expectations (right).

Distribution of the parentâ&#x20AC;&#x2122;s assessment of the likelihood that a child would be in jail by 20
(left) and the likelihood that a child would be a parent by 20 (right).

Distribution of the simple average of
parental expectations (left).

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Outcome Variables
The dependent variables tested were:
1.
2.
3.
4.

The number of arrests a participant has had through their 2011 interview.
Whether the individual was enrolled in school or employed in 2011,
The highest grade completed by the 2011 interview, and item
Total and logarithmic income in 2010 (if employed).

Most of these variables are provided in the most recent NLSY round. I constructed the “enrolled
or employed” variable based upon the participant's answers to whether they received income in
the past year and whether they were currently enrolled in school.
I also compared the results of my regression to the 2005 round of data. There was some concern
that the 2008 economic crisis may have disproportionately affected some subgroups of the sample
and thus could affect the regression coefficients for employment outcomes.
Regression Adjustment
The primary analysis method used is regression adjustment to see the relation between higher
expectations and outcomes while controlling for other factors including age, gender, race,
socioeconomic background (mother's education and family income), geographic region/
urbanicity, and ability (as measured by a participant's ASVAB score).
To make the regressions easier to interpret, the expectations were combined into two indices
groups:
1. Positive expectations
a. Chance of obtaining a high school diploma by age 20
b. Chance of obtaining a college degree by age 30
c. Chance of working by age 30
2. Negative expectations
a. Chance of being in jail by age 20
b. Chance of being a parent by age 20
Each “chance” was the percent likelihood that a child would obtain or achieve the stated outcome.
The indices were calculated three different ways:
1. Simple average: The first index was a simple average of all the expectations included
in the index.
2. Average of normalized scores: Due to the low correlation between various
expectations, a second index was the average of normalized scores. Each expectation
was normalized individually, and then the normalized scores were averaged.
3. Above average expectations: Using the simple average index, a binary was made for
whether parental expectations were above or below the average of the index. Thus, a
“1” on the above average positive expectations index means that a parent viewed the
chance of their child completing high school, college, and working as more likely
than what the average parent expected. A “1” on the above average negative index
means that a parent viewed the chance of their child going to jail or being a parent as
a teenager as being more likely than what the average parent expected. A “0” in

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either means that the parent viewed the likelihood of the relevant outcomes as less
than what the average parent expected.
Regression Adjustment with Subgroups
Finally, since much of the recent research on the topic has analyzed the impact of parental
expectations within a particular racial or socioeconomic subgroup, interaction terms were used to
see if subgroups responded to expectations differently.
Figure 2 and Figure 3 show the distributions for expectations generally as well as within
subgroups. The results were consistent with prior research: using a simple t-test, the distributions
differed at the 95 percent confidence level (see Table 3). As with prior research, it appeared that
on average, African Americans, Hispanics, and families below the poverty line had lower positive
and higher negative expectations. On the other hand, Asian Americans had higher positive and
lower negative expectations. However, it is unclear if the differences are practically significant.
For example, the average difference in expectations for African Americans was only a couple
percentage points from the expectations for the rest of the sample population. However, the
differences for families below the poverty line do seem practically significant (e.g., the 9.4
percentage point average decrease in positive expectations).9
Regardless of practical significance, because there were differences, the regressions were also run
with interaction terms between above average expectations and being in a subgroup. This analysis
would show whether expectations affected subgroups differently.!
Results
General Results
The first set of results is for regressions with the various expectations indices (i.e., not including
the subgroup analysis). The results are shown in Tables 4-9, and Table 14 summarizes the
relevant coefficients. In all of the regressions, the coefficients on gender and ability (ASVAB)
were statistically significant. Age was significant for certain outcomes (highest grade completed
and income). All of the relevant coefficients for expectations are significant at the 99 percent
confidence level except:
"
"

Coefficients of negative expectations (simple average and average of normalized
scores) and income. These coefficients appear to be approaching significance,
however.
Coefficient for above-average negative expectations on being enrolled or employed
in 2011.

Interestingly, in most cases, the magnitude of the coefficient for positive expectations was larger
than the magnitude of the coefficient for negative expectations. This suggests that children and/or
teachers respond better to positive reinforcement or that parents are better at communicating their
hopes for their children rather than concerns.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
9

Because of the different scales used to gauge expectations, I could not directly compare the magnitude of
my results to those in prior research. Additionally, in the papers I read, I did not see any discussion of
practical versus statistical significance.

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Subgroup Results
However, the practical significance of these results is unclear. For example, having aboveaverage positive expectations is correlated with a decrease of less than one arrest by 2011, an
increase in the chance of being enrolled or employed, and one additional grade level completed.
Similar coefficients are seen for the other variables. The only ones that might be practically
significant are the income effects. Having above average positive parental expectations is
correlated with about $5,400 higher average annual wages if employed, and having above
average negative expectations is correlated with about $2,800 less in average annual wages.
The lack of significance suggests that expectations affect subgroups in the same way as other
groups. This finding is in opposition to most of the previous research.10 Ideally, I would like to do
a more in-depth search of previous research and see how many longitudinal studies produced
similar results. Additionally, as mentioned before, I did not see other studies discuss practical
significance, which did find differential effects across subgroups. This difference may be due to
the fact that this study makes use of a longitudinal survey, or other details. Further research on
this point is necessary, but the present analysis using NLSY data, which is rather extensive,
shows that subgroups internalize expectations in the same way.
Comparing with 2005
As mentioned above, there was some concern that the economic crisis may have
disproportionately affected some groups of the sample population. Conducting the same
regressions for the 2005 data, we find no statistically different coefficients except:
"

"

Highest grade completed: the 2011 coefficients of positive and negative expectations
on highest grade completed were slightly higher than the 2005 coefficients. The 2005
95 percent confidence intervals for the coefficients were [0.321, 0.529] for aboveaverage positive expectations and [-0.307, -0.145] for above-average negative
expectations. The 2011 95 percent confidence intervals for the coefficients were
[0.816, 1.339] for above-average positive expectations and [-0.623, -0.221] for
above-average negative expectations.
Income and negative expectations: the magnitude of the coefficient for negative
expectations on 2011 income (if employed) was slightly larger than the magnitude of
the corresponding 2005 coefficient, but the difference was only a couple hundred
dollars.

However, these small differences between the 2005 and 2011 coefficients are unlikely to have
been practically significant. The interaction terms were also not significantly different. Many of
the relevant 2005 coefficients were not statistically different from zero as well, reinforcing the
conclusion that subgroups internalized expectations in the same way as majority groups.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
10

Ideally, I would like to do a more in-depth search of previous research and see how many longitudinal
studies produced similar results. Additionally, as mentioned before, I did not see other studies discuss
practical significance.

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Discussion and Policy Implications
This analysis suggests that expectations are highly correlated with outcomes in both majority
groups and subgroups. Using the conclusions of Yamamoto, the results suggest that policies
should be implemented to address parental expectations. 11
First, policies must be developed to address the causes of low expectations held by some parents.
If low expectations are due to parents not understanding the system well or not trusting it, policies
should be focused on better informing parents. Schools could send information home to parents
(e.g., with report cards or test results) and require children to bring the forms back with parent
signatures, and many already do. However, a better policy would directly involve parents. Those
that can come to their child's school during the day should be incentivized to do so, and those
who cannot should be given other opportunities (e.g., require a child's homework to involve the
parent). These policies would be especially important if the goal is to provide equal opportunities
across subgroups. Even if subgroups internalize expectations the same way, as this study
indicates, they start out with a different set of expectations. Finding out why these differences
exist and addressing the underlying causes will be key.
Second, policies should be aimed at how expectations are internalized. A simple survey could ask
children about what their parents expect. These results would allow researchers to understand
which expectations children internalize, as well as make teachers and administrators aware of
which children may be in less supportive home environments. Positive feedback from teachers
could then be used to counteract low parental expectations. Additionally, teachers should be
trained to handle the differences. They should be aware of parental expectations and their effects,
and gauge their feedback to students accordingly. Presently, there is a tendency for teachers to
focus on children from higher-expectation families in order to fulfill those high expectations.
Teachers need to be aware of why they are focusing on certain children so they can better
calibrate their classroom efforts.
Conclusions
NLSY provides a unique opportunity to observe the long-term correlations between parental
expectations and educational and employment outcomes. Consistent with previous research,
expectations were highly correlated with outcomes. At the 95 percent or higher confidence level,
positive expectations were positively correlated with better educational and employment
outcomes, and negative expectations were negatively correlated with these outcomes. However,
the practical significance of these relationships remains unclear.
Additionally, expectations differed significantly between subgroups (minorities and poorer
families), but again the practical significance of these differences is unclear. The directions of the
differences were also consistent with past research. Most notably, in contrast to previous
research, differential effects between subgroups were not found. Interaction terms in the
regressions produced no statistically significant coefficients. This finding suggests that
internalization of expectations happen the same way across groups, and so policies that target the

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
11

Yamamoto and Holloway.

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causes of differing expectations will be needed to equalize chances for children from different
backgrounds.
This analysis also suggests that policy intervention is needed to increase the awareness of the
correlations between expectations and outcomes. Teachers should be aware of which children
may need more support if they are not receiving it at home so they can act accordingly.
Future research should look into the causes of differing expectations. If these were indeed due to
parental characteristics and not to a childâ&#x20AC;&#x2122;s performance and abilities, it would strengthen the
argument for policies that are aimed at informing and involving parents. Finally, internalization
mechanisms should be investigated further in order to pinpoint where policies would be most
effective. !
Christine O'Donnell is an MPP candidate at the University of Virginia. Her undergraduate work
was in astrophysics, and she will begin study towards an astronomy PhD in Fall 2014. Christine
is interested in science communication through teaching, outreach, policy, and other means, and
she hopes to pursue these interests through her graduate work and future career. Please direct
any questions or requests to the author at cao4fq@virginia.edu.

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Early Identification of High-Achieving, Low-income Students
and Their College Participation Rates
Lena Shi
Using the 1997-2007 National Longitudinal Survey of Youth (NLSY), I analyze the effects of
socioeconomic status (SES) risk factors, specifically mother’s high school graduation and poverty
status, on students’ participation in college entrance exams, college enrollment, and college
completion. In particular, I evaluate whether socioeconomic factors disadvantage early highperforming students, defined as those scoring above average on the Peabody Individual
Assessment Test (PIAT) in middle school or early in high school. I find that having each
additional risk factor decreases the probability of taking the SAT or ACT, enrolling in college,
and completing college, even for early high-performers. Many students who show strong
academic potential as early as middle school actually drop off the college admissions path
altogether. This research also suggests that an accurate cognitive indicator like PIAT can help
policymakers identify and engage high-achieving, low-income students in the challenging college
preparedness process at an earlier age.
Background
A symbolic ladder for social mobility, higher education significantly expands postgraduate
opportunities.1 Low-income children, however, are 80 percent less likely to attend college than
high-income children.2 Unequal access and participation in quality education largely explains
why children predominantly inherit the same economic position as their parents today.3 Despite
decades of efforts to remedy socioeconomic inequalities in college participation, low-income
students remain underrepresented at selective post-secondary institutions across the nation. Even
among high-achieving students, only 34 percent attend one of the country’s most selective
universities if they come from low-income families, even though selective institutions, on
average, offer students a lower net-tuition rate, better match their abilities, and increase future
earnings.4 Low-income students are under-participating in higher education opportunities.

Figure 1. Regression Model of Relationship between Background Factors and PIAT [n=6044].
All p-values < 0.01
A lack of qualifications, however, has not alone caused the group’s low college participation rate.
Studies show that primary indicators of successful college preparedness are information and
encouragement, two factors that high-achieving, low-income students have less exposure to
compared to their middle-income and higher-income peers. 5 Being under-informed about college
affordability, for example, represents a significant barrier to participation. Recent research
suggests that a misunderstanding of the high tuition rates and financial aid resources deter many
high-achieving, low-income students from believing they can attend colleges, especially the topranking institutions.6 Those schools’ published annual tuition and fees rates often exceed the
nation’s average household income; selective private schools often have the highest sticker tuition
price.7 However, low-income students would pay the lowest net tuition price at these schools,
given the school’s available financial aid resources, particularly grants and scholarships, etc.
Another deterrent is low-income students’ low expectations about college participation because
they have weaker guidance counseling programs, less community encouragement about college
participation, and less exposure to college alumni. Compared to their middle- and upper-income
peers, low-income students have less access to quality college information and support
throughout the complex admissions process.8

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
5

Hoxby and Avery.
Caroline M. Hoxby, ed., College Decisions: The Economics Of Where To Go, When To Go, And How To
Pay For It, (Chicago: University of Chicago Press, 2004).
7
Digest of Education Statistics. “Table: Average undergraduate tuition and fees and room and board rates
charged for full-time students in degree-granting institutions, by level and control of institution: 1964-65
through 2010-11.” http://nces.ed.gov/programs/digest/d11/tables/dt11_349.asp.
8
Hoxby and Avery.
6

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Today, successful college preparedness heavily involves both the schools and parents, leaving
low-income students at an even greater disadvantage. Parents are the strongest influences in
students’ postsecondary decisions, but low-income and first-generation students often receive less
personalized academic advising from family members. 9 Low-income parents often cannot
provide accurate information about course planning or about financial planning. In fact, lowincome parents often under-participate in college savings programs and are often not fully aware
of the various forms of available financial assistance. 10 The increasing complexity of the
admissions process, academic planning, and financial aid application represents a growing
challenge for high-achieving, low-income students to overcome alone.
Motivation
College is not for everyone. However, low-income students with high academic potential miss or
do not consider college opportunities because of socioeconomic disadvantages beyond their
control. Rather than increasing college enrollment for everyone, a suitable policy should aim to
remove the barriers to college enrollment for students who desire to participate.
Important college admissions decisions now start as early as middle school. Successful college
admissions heavily depend on academic planning, as the primary admissions criteria heavily
stress college prep classes’ GPA, standardized tests, and course rigor.11 Although lower-income
students are more frequently misplaced out of high-level classes, better identification of highachieving low-income students can help open more opportunities to higher education. 12 For
example, 71 percent of low-income students who were placed in geometry class by ninth grade
went to college.13 Therefore, today’s policy interventions that occur in high school are helpful,
but exclude the importance of identifying and supporting low-income students throughout their
K-12 career.
Most of today’s interventions primarily identify high-performing students in high school, after
they have taken the PSAT, SAT, or ACT and disclosed their GPAs. For example, QuestBridge
matches low-income students with high college entrance exam scores while highly ranked and
selective universities offer free tuition for admitted students with annual family income of
$40,000 (some even $80,000) and below. Some of the most common policies to improve college
access may only benefit the small group of high-achieving low-income students who have
successfully planned academically, as well as performed well in high school and on college
entrance exams.

!
By the time policymakers identify high school juniors and seniors from college entrance scores
and GPAs, they have already excluded the population of high potential students who lowered
their academic engagement because they never considered college as an option. By late high
school, students may find it too late to drastically commit to the college preparation and
admissions process. College eligible and high-performing sophomores and juniors, for example,
may be overwhelmed: there are too many choices to navigate; there are high tuition rates that they
have not saved for; there are too many documents and applications to keep track of alone etc.
Policies that use GPA and college entrance exam scores to engage students in college
preparedness will likely exclude high-potential students.
Therefore, I use the Peabody Individual Assessment Test (PIAT), which is an alternative tool to
identify high-achieving low-income students. Students may begin taking the PIAT after age five,
giving schools and policymakers more time to effectively engage high-performing students and
their families throughout the complex and challenging college-preparedness process. The PIAT is
an academic performance indicator that has high reliability and re-testing results, and has not yet
been utilized by many higher education policy researchers as a tool for increasing college
participation among low-income students.
Research Questions
Using the 1997-2007 National Longitudinal Survey of Youth (NLSY), I explore the relationship
between explanatory variables, early academic performance and socioeconomic status (SES) risk
levels, and their effects on college participation. The two explanatory variables are the 1) PIAT
score, which indicates students’ academic potential, and 2) the SES risk levels. SES risk levels
are determined by whether the mother has graduated from high school and/or if the student lives
in, at, or below the poverty line.14 The outcomes of interest are 1) whether the student takes a
college entrance exam (specifically the SAT or ACT), 2) whether the student enrolls in college,
and 3) whether the student completes college. The central research questions guiding the research
study are the following:
•
•
•

Is there a relationship between students’ SES risk factors and their academic performance
on the PIAT?
Is there a relationship between students’ SES risk factors and their college participation?
Among high-performers on the PIAT, how does SES risk affect college performance?

Empirical Approach
Using the NLSY, I measure the students’ explanatory variables during childhood in 1997. I then
evaluate the students’ college participation outcomes by 2007. I only include the students who
would have reached college graduation age by 2007.
Dependent Variables. I evaluate three primary college participation outcomes through indicator
variables for whether or not an individual completed a specific outcome (1 = yes, 0 = no). First I
evaluate whether the student took the SAT or ACT by 2007, demonstrating their participation in
the college admissions process. Second, I evaluate whether the student has enrolled in a two-year

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
14

The poverty level is determined by Health and Human Services ASPE.

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or four-year higher education institution. Finally, I evaluate whether the student has completed a
two-year or four-year higher education institution by 2007.15
Explanatory Variables. The explanatory variables are academic performance and three levels of
SES risk. Academic performance is measured by whether the student performed above or below
the average PIAT score of 93.90. SES risk level reflects whether the student satisfies zero, one, or
two risk factors; they are illustrated in the matrices below. A ‘high SES risk’ level identifies a
student whose mother did not graduate high school and who lives at or below the poverty line. An
‘SES risk’ level corresponds to a student whose mother did not graduate high school or who lives
at or below the poverty line. A ‘no SES risk’ level corresponds to a student who lacks both
factors. I also created an interaction variable between whether the mother graduated from high
school and whether the students come from households living below the poverty line. The
following matrices explain the construction of the explanatory variables.
Matrix 1. Interaction term

Matrix 2. SES Risk Level

Covariates. I controlled for student characteristics, including age, gender, race/ethnicity,
geography, and background factors like household income, household size, home language, etc.
Methods. To determine the relationship in question, I used a basic multi-variable regression. The
basic model is shown:
!! = ∝ +!SES + !!! + !Interaction! + !!
In the model above, Y! represents the college participation outcome in question, ! is the
coefficient for the SES risk level, ! is the coefficient for the covariates, and ! is the coefficient
for the SES interaction variable. I ran models for all the outcomes of interest. ! is the error term.
The analyses also considered the correlation between explanatory variables and covariates.
Finally, I ran the regressions to discover differential effects in college participation outcomes
among individuals who possessed different explanatory variables.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
15

The study evaluates whether the students who took the PIAT score in 1997 participated in college by
2007; which evaluates their direct transition from high school to college. Theoretically, those students
could have gone back to earn their degree since 2007.

Note. The reference group for race is “other.” Math's constant is about 4 and Verbal is 4.42,
which both correspond to a performance range of 501-600. The ACT constant is 4, which
corresponds to a performance range of 19-24. Figures in parentheses are standard errors:* p <
0.10, ** p < 0.05, ***p <= 0.01.

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Students who have high SES risk factors are more likely to live in urban areas and speak a home
language other than English (ESL). Poverty and uneducated mothers have the greatest
correlations with having one or more SES risk factor. Although comparatively, race has a weaker
correlation with SES risk, black and American Indian individuals show positive correlations with
SES, while white and Asian individuals show negative correlations with SES.
Students with SES factors are less likely to perform above average on the PIAT. Compared to
students without SES risk, three groups perform worse: high SES students (9 percent worse), SES
students (4 percent worse), and ESL students (3 percent worse). Thus, I can conclude that
students with one or more SES factor face challenges to performing well academically.
Figure 3. Took SAT/ACT, Enroll, Completed by controls.
Explanatory
Variable
Dependent Variable
SAT/ACT

!
and high school students. PIAT also positively correlates with college entrance exams. Thus,
performance on PIAT is likely to help predict the performance on college entrance exams later in
the studentsâ&#x20AC;&#x2122; academic career.
The following results evaluate how SES risk factors affect high-achieving students, who score
above average on the PIAT:
High-performing, high SES risk students are less likely to take the SAT and ACT. Each additional
SES factor correlates with an increasingly lower probability of taking the SAT and ACT. Thirtythree percent of high SES students take college entrance exams, compared to 55 percent of SES
risk students and 72 percent of no SES risk students. High SES risk produces a greater negative
effect than that in the SES interaction variable. SAT math scores are lower among females, ESL
students, and poor students while SAT verbal scores are lower among students who are black and
have a larger household size. Students living in urban areas do better on both tests. Overall, the
individual variables of being low-income and having an uneducated mom lead to a lower
probability of taking the SAT and ACT, but the SES risk interaction variable leads to an even
lower probability of taking college entrance exams.

Figure 4. Summary Table of SES impact on High-Achieving Studentsâ&#x20AC;&#x2122; College Participation
Rates. All p-values < 0.01.
High-performing, high SES risk students are less likely to enroll in college. Less than half of
high-performing, high SES risk students will enroll in college, compared to 80 percent of students
without SES-risk. The SES interaction variable shows a college enrollment probability closer to
that of no SES-risk group. Female, Asians, urban, and educated mom variables show higher
probabilities with college enrollment. Overall, being low-income and having an uneducated mom
are each factors that individually lead to a lower probability of enrolling in college. The combined
effects of SES-risk lead to an even worse probability of enrolling in college.
High-performing, high SES-risk students are less likely to complete college. High-performing
students with high SES risk have the highest college dropout rate, and therefore lowest college
completion rate at approximately 26 percent, which is more than double that of high-achieving

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students with no SES-risk. Female, Asians, white, and educated mother variables show higher
probabilities with college completion. Overall, the individual variables of being low-income and
having an uneducated mom lead to a lower probability of completing college, but the combined
effects of SES-risk lead to an even lower probability of completing college.
Discussion and Limitations
Through this research, I have drawn the conclusion that SES-risk lowers the level of PIAT
performance as an adolescent. Even among those who performed above average on the PIAT,
showing early potential for high cognitive performance, SES-risk lowers the probability of taking
a college entrance exam, enrolling in college, and ultimately completing college. This finding
suggests that PIAT is an alternative, and potentially stronger academic indicator for higher
education policy-makers, who can target and engage high-achieving, SES-risk students at an
earlier age to prepare them for college education.
This research also suggests that poverty and uneducated mothers affect students’ participation
differently. A mother’s education affects the amount of support that the student receives; an
uneducated mother correlates with low rates of student participation in taking college entrance
exams, as well as with college enrollment and completion. A student’s poverty status, on the
other hand, affects academic performance; low-income students have the lowest performance on
early cognitive and college exams. ESL students are more likely to possess both these factors.
Depending on the schools’ and policymakers’ priorities of participation versus performance,
policies will need to be different. For instance, for students with uneducated mothers,
policymakers may consider school-based strategies to encourage and support college entrance
exam preparation and preparedness. For low-income students, policymakers may want to focus
on improving educational and teacher quality. Both poverty and an uneducated family reinforce
academic disadvantages for youth.
Additionally, this research shows that admissions and college fail to include and produce
successful academic outcomes for low-income students. Policies to increase college participation
among high-achieving, low-income high school students – such as college admissions recruiting,
campus visits, and college mentoring programs – will likely be ineffective if students have no
prospect of participating in college. In addition, early identification of high-achieving, SES-risk
students can catalyze new K-8 initiatives for higher enrollment, particularly in earlier and more
personalized college identification and preparation programs. For example, policymakers could
also offer guaranteed financial aid packages to young students contingent on academic
performance. Informed of the disadvantageous effects of SES on high-performing students,
policymakers can better engage students to be more academically and financially prepared at an
earlier age. Furthermore, knowing the unequal admissions, enrollment, and completion rates,
colleges should not limit their support to the application process, but should also consider ways to
support high-achieving, low-income students throughout their time at the institution.
It is important to note, however, that this research suggests a correlation, not causation, in the
relationship between explanatory and outcome variables. The NLSY data shows that only 25
percent of those not labeled an SES-risk, which is significantly lower than national

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16

demographics. Further, the study only measured the college participation of high-achieving lowincome students, which had a sample size of 176 students, which is approximately ten percent of
the high SES population. Although this study appears to be randomized, the sample size is not
representative of national trends.
Additionally, many recent policies have taken place to support high-income low-income students.
The participants in the 1997-2007 survey are now in their thirties, and did not benefit from
today’s wave of college preparedness reform, so more relevant data is available than at the time
of the survey. Today’s K-12 reform strategies and existing higher education initiatives to promote
enrollment and completion among high-achieving, SES risk students may be more effective
today. Further, I used a ten-year lapse of NLSY data, which requires a long length of time to
measure kids’ later outcomes. The longitudinal aspect of this data, required for analysis of the
effects of intervention on long-term outcomes, challenges the need to find urgent solutions.
Today’s policy-makers must respond swiftly to the current higher education initiatives and
therefore need a faster turn-around for outcomes. An alternative could be to set earlier and
follow-up interim outcomes, such as enrollment in a college savings account or meeting with
guidance counselors after intervention.
Overall, this evidence suggests that PIAT can be a reliable academic indicator policymakers can
use to identify high-achieving students with SES risk, especially now that research has shown that
even students who score highly on the PIAT have lower participation than their peers because of
socioeconomic factors outside of their control. Given the available research, policymakers can
more effectively work to break down the barriers that impede high-achieving students’
participation in higher education opportunities. !
Lena Shi is a 2014 Master of Public Policy candidate and a 2013 Global Development Studies
program graduate from the University of Virginia. A Charlottesville native, Lena is most
passionate about expanding educational opportunities for youth. She will be working on
education policy in Washington D.C. next year.

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16

U.S. Census Bureau, “Income, Poverty and Health Insurance in the United States: 2011 – Highlights,”
Last modified 2011. http//www.census.gov/hhes/www/poverty/data/incpovhlth/2011/highlights.html.

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Fuzzy Relationships: Procedural Justice and Citizen
Cooperation in Developed and Developing Countries
Jaehee Park
The process-based model of regulation suggests that policies eroding public confidence and
support, such as New York City’s Stop and Frisk, lead to lower rates of citizen cooperation with
authorities. After Sunshine and Tyler’s seminal 2003 article introducing the process-based
model, additional researchers have examined the relationship between procedural justice, or
citizens’ perceptions of fairness, and levels of cooperation with government authorities. This
paper’s meta-analysis of seven independent studies finds a modest correlation between
procedural justice and cooperation (ρ=0.367). My results suggest that socio-economic context
moderates the relationship between procedural justice and cooperation. The procedural justicecooperation relationship was stronger in developed countries (ρ=0.376) than in developing
countries (ρ=0.271). Researchers should further explore data from developing countries to
determine how factors differentiating developed and developing nations influence relationships
between authorities and citizens.
Introduction
A citizen’s views of the legitimacy of a legal authority can influence his or her willingness to
comply with regulations.1 Citizens, as a result, may refuse to cooperate with the police because
they distrust law enforcement officers.2 Psychologist Tom Tyler concludes that when people
perceive that legal authorities treat them respectfully and make decisions in a trustworthy, neutral
and transparent way, citizens will view the police as more legitimate. 3 This trust leads to
cooperation.4 Known as the “process-based model,” Tyler suggests that the authorities’ abilities
to reduce crime and interact with citizens are key to public trust and support.5 This model

!
assumes that citizens’ cooperation with police is grounded in their confidence in the police
service.6
Empirical evidence explaining the connection between procedural justice and cooperation
continues to grow. 7 Despite the increasing acceptance of the process-based model, several
fundamental issues remain. Since most studies rely largely on samples from developed countries,
the strength of the relationship between procedural justice and cooperation and the implications
of this relationship may not be valid in other contexts. To address these issues, I conducted a
meta-analysis of seven studies that reported correlation factors between procedural justice and
cooperation with examined research context as a moderator. This meta-analysis seeks to evaluate
the strength of the relationship, as well as the extent to which its magnitude changes within
different socioeconomic and authoritative contexts.
Operationalization of procedural justice and cooperation
To measure procedural justice, all seven studies used two key components of procedural justice
drawn from the relational model of authority — quality of decision-making and quality of
interpersonal treatment. Specific components were used to measure concepts of voice, respect and
neutrality, indexing voluntary cooperation with authorities, measure self-report compliance
behavior, and capturing willingness to help police officers.
Method
Literature search & Inclusion and exclusion criteria
Sunshine and Tyler’s process-based model is one of the most influential frameworks for
procedural justice in the context of legal authority.8 As a preliminary step, I conducted an
extensive literature search for studies published after Sunshine and Tyler’s that included the
keywords procedural justice, procedural fairness, cooperation, police, and legitimacy. The
primary criterion for inclusion in this meta-analysis was that the study reported correlation
between a measure of procedural justice and a measure of cooperation. Although many criminal
justice and organizational justice studies measure both procedural justice and cooperation, very
few studies reported the observed correlation between the two constructs. Therefore, many
studies of criminal justice and organizational justice were excluded from the current analysis. On
the basis of this criterion, I included seven correlations from seven studies. All seven studies
reported the effect size in terms of a correlation coefficient (r) and reliabilities of each
measurement (Cronbach’s α).
Moderator Variables
Two study characteristics were coded as potential moderators of the relationship between
procedural justice and cooperation. These traits were 1) the research context (police versus nonpolice) and 2) the country of study (developed country versus developing country). In line with
the International Monetary Fund’s World Economic Outlook Report, the United States and

!
Australia are identified as “developed countries” and Ghana and Jamaica are identified as
“developing countries.” 9 Potential moderators included police versus non-police states and
developed versus developing countries.
Research
context

Developing Reisig & Lloyd (2009) Tankebe N/A
countries
(2009)
(Murphy, Tyler, and Curtis, 2009, a: taxation context; b: social security context; c: law
enforcement context)
Meta-analysis procedure
I used psychometric meta-analysis, also known as the Hunter & Schmidt Random Effect MetaAnalysis, to correct a distribution of observed correlation coefficients in order to estimate the
distribution of population coefficients.10 For the overall meta-analysis and the moderator metaanalysis, I made corrections to account for the unreliability of both procedural justice and
cooperation measures and for sampling error.
The meta-analytical results include the weighted mean (r), the standard deviation of the weighted
mean (σ), and the sampling error variance (σ2SE) of the observed distribution. The results provide
an estimated mean of the population distribution (ρ), the standard deviation of the population
distribution (σρ), and the credibility interval (95 percent CR). The standard deviation of the
population distribution (σρ) represents the degree of dispersion remaining after sampling error
variance, and the variance due to other artifacts has been removed from the observed variance.11
The credibility interval can help us determine if moderators exist. If the credibility interval is
wide, I need to explain the source of the remaining variance. The source of the remaining
variance could be attributed to moderators or to statistical artifacts for which no corrections were
performed.
Results
Relationship Between Procedural Justice and Cooperation
The weighted mean correlation between procedural justice and cooperation was 0.38. Across all
seven studies, the estimated population value for the procedural justice-cooperation relationship
was 0.46, CI95 = [0.05, 0.88] (see Table 2). However, this number might overstate the true
population mean because there is a potential outlier in this study. De Cremer and Tyler’s

!
correlation (r=0.77) is much higher than that of the other studies. After deleting one extreme
effect size (r=0.77), the weighted mean correlation between procedural justice and correlation
changed to 0.37 CI95 = [0.27, 0.47] (see Table 3). Thus, the outlying study was responsible for
substantial heterogeneity in the distribution of effects.12
Homogeneity
To evaluate population homogeneity, I employed the 75 percent rule.13 This rule states that the
presence of moderators is likely if more than 25 percent of the population variance remains after
correcting for sampling error and other correctable artifacts in the procedural justice or
cooperation measures.14 Sampling error explains less than one percent of the variance in the
correlation (see Table 2), suggesting moderators were likely present. The large credibility interval
[0.05, 0.88] also suggests the presence of moderators (see Table 2).
Moderator Analysis
For the initial assessment of the context specificity of the procedural justice and cooperation
relationship, I performed four separate meta-analyses of studies involving developed countries
(k=5) versus developing countries (k=2) contexts and police authority (k=5) versus non-police
authority (k=2) contexts.
In the psychometric meta-analysis literature, two criteria should be satisfied to classify a factor as
a moderator: the estimate population mean of at least one moderator subgroup should differ from
the estimated population mean of the distribution of all effects, and the estimated population
standard deviation for all moderator subgroups should be less than the standard deviation for the
distribution of all effects. Often more consideration is given to the subgroup mean effect
differences than is given to the subgroup differences in estimated standard deviations.
With respect to country context (developed compared to developing), both subgroup means (ρ
developed =.477; ρ developing=.271) differ from the mean of the distribution of all effects (ρ=.463).
However, the developed country subgroup population standard deviation is slightly larger than
the population standard deviation of all effects (σρ developed=.21332> σρ=.21245). Conversely, the
developing country subgroup population standard deviation is smaller than the population
standard deviation of all effects (σρ=.21245> σρ developing=.02102). A second potential moderator in
my study is authority context (police authority versus non-police authority). Both subgroup
means (ρ police =.475; ρ non-police=.302) differ from the mean of the distribution of all effects
(ρ=.463). However, police authority context studies’ population standard deviation is slightly
larger than the population standard deviation of the distribution of all effects (σρ police=.21273>
σρ=.21245). The population standard deviation for non-police authority context studies is less
than the population standard deviation of the distribution of all effects (σρ=.21245> σρ nonpolice=.12565). Thus, neither of the two potential moderators satisfies the criteria.

!
After deleting an extreme sample (r=0.770) from the outlying study, I reran the four separate
meta-analyses for studies involving developed countries (k=4) versus developing countries (k=2)
contexts and police authority (k=4) versus non-police authority (k=2) contexts.15 With regards to
the country context, both subgroup means (ρ developed =.376; ρ developing=.271) differ from the mean
of the distribution of all effects (ρ=.367). Furthermore, both subgroup population standard
deviations are smaller than the population standard deviation of the distribution of all effects (σρ
developed=.05450< σρ=.05988; σρ developing=.002102< σρ=.05988). Thus, country context is likely a
moderator of this relationship.
In my analysis of the second potential moderator (police authority versus non-police authority), I
found that both subgroup means (ρ police =.373; ρ non-police=.302) differ from the mean of the
distribution of all effects (ρ=.367). The studies of police authority have a population standard
deviation that is smaller than the population standard deviation of the distribution of all effects (σρ
police=.04458< σρ=.05988). However, the population standard deviation for non-police authority
context studies is larger than the population standard deviation of the distribution of all effects
(σρ=.05988<σρ non-police=.12565). Thus, the police versus non-police authority context fails to
satisfy the criteria and cannot be considered a moderator.
Discussion
The meta-analysis, after one extreme effect size (r=0.77) was omitted, indicates a modest
relationship between procedural justice and cooperation (ρ=0.367). This relationship was
moderated by one of the research contexts. Studies in developed countries highlighted a stronger
procedural justice–cooperation relationship (ρ=0.376) than was evident in studies of developing
countries (ρ=0.271). Socio-economic and cultural factors may cause the difference, since they
differ significantly between countries and shape the power relationship between legal authorities
and citizens. For example, Jamaican police misconduct such as unnecessary force and corruption
disrupts their relationship with citizens.16 In Ghana, citizens’ views of police trustworthiness did
not seem to relate to their expression of obligation to obey police orders.17 These case studies
suggest that the process-based model does not explain the developing countries as well as it does
the developed countries that have, to date, been explored.
However, a large amount of residual variance remained even when I accounted for socioeconomic contexts. This result suggests that other moderators were unaccounted for in the study.
Moreover, the number of study samples is too small (k=7) to clearly interpret the current finding
within the contexts. When more studies enter this meta-analysis, I can obtain a more accurate
estimate of the population variance. Nonetheless, it is worth noting that this is the first study that
provides a systematic investigation of the relationship between procedural justice and cooperation
using peer-reviewed meta-analysis techniques. Moreover, this study provides a direction for
future research on the process-based model. Researchers should pay more attention to a variety of
cultural settings, particularly in developing countries, to make more definitive claims about the
generalizability of the process-based model beyond the developed world.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
15

DeCremer and Tyler.
Reisig and Lloyd.
17
Tankebe.
16

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38

Virginia Policy Review

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Conclusion
This analysis suggests that the country context, particularly economic development status, may
moderate the central relationships of the process-based model—the relationship between
procedural justice and cooperation. This analysis reveals that the process-based model might
more accurately describe developed countries, however, it does not indicate that the processbased model is not applicable in developing countries. The model has been built on evidence
from the United States to show the effect of legitimacy of legal authority on a citizen’s
cooperation with regulations. The process-based model should be tested in more socioeconomically and culturally diverse contexts to establish its applicability beyond the developed
world. Applying the process-based model to more diverse context would provide a more robust
understanding of the procedural justice system as applied in all socio-economic contexts in order
to help shape policies surrounding the justice system. !
Jaehee Park is a third year doctoral student and graduate assistant in the L. Douglas Wilder
School of Government and Public Affairs at Virginia Commonwealth University. His recent
research focuses on international faculty mobility. He is also interested in examining the
interaction between citizens and legal authorities regarding trust and legitimacy.

The Debt Reform Proposals and the Potential Impact of
Implementation on Medicare, Medicaid and Cancer Patients
Sarah Thompson Schick
Introduction
Medicare and Medicaid are the most visible health insurance programs in the United States. Since
implementation, both programs have expanded to cover the exponential increase in numbers of
elderly, low-income, and disabled individuals. Maintaining coverage for the most vulnerable
patient populations is imperative. But over the last few years, with the economy in recession and
a growing number of seniors, Medicare and Medicaid have become government programs in
distress. New solutions and ideas to make both programs fiscally solvent have emerged through a
variety of debt reform proposals.
Cancer patients who are beneficiaries of Medicare and/or Medicaid constitute the sickest
individuals, needing adequate access to care and medical treatment. Researchers have established
a significant link between health insurance status and stage of cancer when diagnosed.1 What is
most important for cancer patients is to ensure that costs are not shifted to state or federal
Medicare and Medicaid beneficiaries, and that nothing disrupts the efficiency and quality of care.
This paper discusses the major reform proposals and their content related to Medicare and
Medicaid. Specifically, I look at the affect that implementation may have on beneficiaries who
are battling cancer, cancer survivors or who seek cancer prevention services. While the research
around each proposal does not comprehensively address cancer care, I include general
information about the proposals and discuss what enactment could mean to Medicare and
Medicaid beneficiaries.
The Proposals
There are six major debt reform proposals that have been introduced over the last five years. They
include:
• The President’s Plan for Economic Growth and Deficit Reduction
• The Senate “Gang of Six” Proposal – “A Bipartisan Plan to Reduce Our Nation’s
Deficits”
• The National Commission on Fiscal Responsibility and Reform (Simpson-Bowles)
• The Debt Reduction Task Force 2010 and 2011 (Rivlin-Domenici)
• The House Budget Committee’s Budget Resolution, The Path to Prosperity – FY2012
and FY2013
• Bipartisan Options for the Future (Ryan-Wyden)

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Medicare
Medicare is one of the largest government expenditures, consisting of approximately 18 percent
of the nation’s Gross Domestic Product (GDP). As the baby boomer population continues to
reach Medicare beneficiary age, reforms are increasingly necessary to maintain Medicare in the
long term. The following reforms are some of the most notable found in the literature and in the
debt reform proposals.
Implement Bundled or Episode-Based Payments
Bundled payments encourage the collaboration of providers to control costs and eliminate
unnecessary care while also improving quality of care administered and patient outcomes.
Bundled payments may be episodic or based on a given period of time.2 David Cutler and
Kaushik Ghosh write that bundled payments will reduce costs and increase efficiencies in overall
care delivery.3 In particular, with more expensive illnesses, such as cancer, bundled payments
increased value in patient care.4
Oncologists who “buy and bill” for chemotherapy drugs are likely beneficiaries of bundled
payments.5 Administrative costs for bundled payments could be less, as cancer patients often
have one provider for an entire treatment period, whereas other bundled payment proposals
consist of multiple providers and multiple services.6 Both physicians and patients could save with
bundled payments, as both are incentivized to opt for lower-priced treatments—whereas in the
current fee-for-service payment system, the incentive is for the physician to select the more
expensive treatment for which he or she will be reimbursed accordingly.7 Bundled payments are
also an opportunity to further improve care for cancer patients. In a system of bundled payments
for cancer care, evidence-based practices for treating specific types of cancer would hold
oncologists to a certain standard of treatment and discourage doctors from avoiding beneficial
treatments for the sake of increasing their profits.8
The available research is unclear, however, as to whether bundled payments in Medicare would
truly work. The Centers for Medicare and Medicaid Services (CMS) implemented voluntary
programs in August 2011, leaving an insufficient amount of information about the effectiveness
of bundled payments.9 Following up with CMS reports about bundled payment programs would
provide the most accurate data, the response of hospitals and providers, and whether the benefit is
realized.

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Increase Cost Sharing Amongst Medicare Beneficiaries
In order to increase savings in home health services, President Obama introduced a proposal that
would charge seniors a $100 co-payment for consecutive home health visits that were not
preceded by hospital or post-acute care treatment.10 The administration would implement this
proposal by 2017, saving about $400 million over a period of ten years.11 The proposal to
increase cost sharing for home health services is consistent with recommendations submitted in
March 2011 by the Medicare Payment Advisory Commission (MedPAC), stating that a “perepisode copay for home health episodes” would encourage Medicare beneficiaries to be more
cost conscious when making individual care determinations.12 MedPAC expressed concern about
the lack of cost sharing for home health services in Medicare unlike other services offered within
the program.13
The President’s budget and the Simpson-Bowles plan discuss the next cost-sharing proposal,
eliminating first-dollar coverage in Medigap plans. Both plans would implement a general cost
sharing requirement for new Medicare beneficiaries who also purchase Medigap plans. Medicare
beneficiaries purchased Medigap plans, or private supplemental insurance, to cover costs of care
that traditional fee-for-service Medicare does not.14
Cost sharing encourages judicious use of health services amongst Medicare beneficiaries.
Medigap plans often shield beneficiaries from the real cost of health care. The National Health
Policy Forum (NHPF) found that while a Medigap cost-sharing plans would yield cost savings,
the affect on spending amongst individual beneficiaries would likely vary due to health status,
amount of service use, and the type of supplemental coverage purchased.15 Although a significant
consensus acknowledges the cost savings of such a plan, opponents highlight other factors
besides over-utilization that impact the increased use of medical services, including
improvements in medical technology.16 The question remains as to whether or not cost sharing
would actually deter beneficiaries from using fewer health care services.17
Amal Trivedi and colleagues found that elderly patients are most sensitive to cost sharing due to
lower incomes, the likelihood of poorer health status, and greater out-of-pocket expenditures on
health care than the nonelderly.18 Trivedi argued that, when cost sharing increases for ambulatory
care services, the elderly suffer an adverse impact.19 Though the use of ambulatory care services
may have decreased as a result, the article noted an increase in the use of inpatient
hospitalizations amongst chronically ill elderly patients, specifically with cancer patients, whose

oncology treatments are notoriously expensive. Cost sharing may impact treatment options and
decisions for Medicare beneficiaries, as ambulatory care is preferable to consistent care.
Additionally, the expected cost savings might be realized, but costs could also shift to other
entities within the health care system.
Introduce Premium Support, Plan Competition, or the Federal Employee Health Benefits Plan
(FEHBP) Model
There are major proposals in support of competition amongst plans for seniors. Mainly, proposals
support keeping traditional fee-for-service Medicare as a public option to compete with private
plans. The Rivlin-Domenici plan proposes that traditional Medicare as the default while
beneficiaries may choose to select a private insurance plan on a health care exchange.21 The goal
of introducing competition between plans is to increase efficiency and quality of care, but there is
no specific evidence as to whether quality and efficiency are guaranteed.22 Also, Rivlin-Domenici
and The Path to Prosperity propose developing Medicare as a premium support program that
limits federal contributions up to a specified threshold.23
The Ryan-Wyden and Simpson-Bowles plan propose that a Medicare insurance exchange be
created and modeled after the Federal Employee Health Benefits Program (FEHBP). 24 The
FEHBP is a health insurance program for federal employees, including members of Congress.25
The government contributes less than 72 percent of the premium costs. For Preferred Provider
Organization (PPO) plans, the cost of premiums is based on an experience rating, while Health
Maintenance Organization (HMO) plans are community-rated.26
There has been criticism of this plan, long before Congressman Paul Ryan, Chairman of the
House Budget Committee, and Senator Ron Wyden proposed it. In 2003, the Commonwealth
Fund published a report about applying the FEHBP model to Medicare and warned that it would
not work for Medicare for a variety of reasons.27 For instance, the report notes that most of
beneficiaries in the FEHBP are located in Washington, D.C. and as a result do not represent a
significantly diverse geographic area like Medicare. Furthermore, most federal government
employees have not reached retirement age. 28 Additionally, although some retirees are
beneficiaries of the program, it is often supplemental to Medicare.29 The Commonwealth Fund

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argues that modeling Medicare after the FEHBP would fail to provide the intended benefits due
to the administrative inadequacies, ill preparation to handle an on-average sicker population, and
the likelihood of adverse selection into high cost plans among beneficiaries.30 The risk of this
occurrence is that it may push viable plans out of the program as they see their costs soar, leaving
fewer plan options for beneficiaries over time. Contrary to the FEHBP, the Rivlin-Domenici plan
fully utilizes community rating incentivizing plans welcoming high-risk beneficiaries. It is
important to take into consideration the issues that are raised by the Commonwealth Fund if the
FEHBP program were implemented by Medicare as is.
No example currently exists of what a program featuring plan choice in Medicare would actually
look like. The literature suggests there are both negatives and positives to implementing such a
program. The Medicare Advantage program is available for seniors who wish to opt into a private
plan, but it does not necessarily compete with traditional fee-for-service Medicare. Like the
bundled payment program at CMS, one possible way to get data on choice-based reform in
Medicare is to introduce a pilot in different regions across the country. Geographic variations,
health status, and other factors should be considered when evaluating the program’s effectiveness
and efficiency.
Medicaid
The federal government funds Medicaid in part, but it is primarily a state-run health insurance
program that is “generally limited to low-income children, pregnant women, parents of dependent
children, the elderly, and people with disabilities.”31 Medicaid must contend with the fiscal
limitations of both federal and state governments, which design their respective programs. Some
of the debt proposals have introduced reforms to Medicaid feasible for the long-term, while
becoming more fiscally manageable for the states and the federal government.
Introduce a Blended Federal Medical Assistance Program (FMAP)
The Federal Medical Assistance Percentage (FMAP) is the dollar amount the federal government
determines it will share in Medicaid costs with the states. The government uses a formula that
calculates a state’s per capita income in relation to the national income per capita.32 States with
lower incomes receive a larger dollar amount than states that have higher incomes.33 Exceptions
to the Medicaid FMAP rate as currently designed by the states include certain women with breast
and cervical cancer. The Congressional Research Service (CRS) explains “for states that opt to
cover certain women with breast or cervical cancer who do not qualify for Medicaid under a
mandatory eligibility pathway and are otherwise uninsured, expenditures for these women are
reimbursed using the enhanced FMAP that applies to the Children’s Health Insurance Program
(CHIP)."34
Currently, FMAP rates for Medicaid and the Children’s Health Insurance Program (CHIP) are
calculated separately, but the blended FMAP proposal would combine the two-into-one single

rate. Under President Obama’s proposal, a blended federal matching rate would be introduced in
2017 and is expected to save $14.9 billion over a ten-year period. The single matching rate is
expected to erase the complication of the current FMAP formula, which must be applied
separately to Medicaid and CHIP while tailoring the matching to the specific needs of states. If a
recession hits and costs to states rise as a result, then the amount of matching from the federal
government would likely increase as well.36
The Center for Budget and Policy Priorities (CBPP) cites two weaknesses in the blended FMAP
proposal. First, it would shift costs to the states; and second, the federal government is likely to
face challenges when calculating each state’s new FMAP rate equitably.37 CBPP explains the
impact on the states mainly would come through administrative costs.38 In the proposal, states
would have to check eligibility under the current FMAP rate and then again when the new rate is
implemented in a few years. 39 An even bigger concern is that states would actually lose
significant amounts of federal funding with the blended FMAP, as the federal government reengineers the formula with previously separate matching rates for Medicaid and CHIP.40 Next,
the CBPP criticizes the assumptions that would go into the blended formula for the Medicaid
expansion under the Affordable Care Act (ACA).41 The Supreme Court rejected the parameters of
the Medicaid expansion under the ACA; states are permitted to opt out of the expansion without
penalties from the federal government, but there are likely some states that will elect to receive
additional funding for newly eligible Medicaid beneficiaries.42 For states that choose to opt into
the Medicaid expansion, the CBPP is concerned that the federal government’s for the FMAP
formula may not reflect the actual fiscal needs of the state. This would result in some states
receiving less funding than needed.43
Expand State Flexibility, Streamline Government Oversight, and Convert Medicaid into a Block
Grant Program
States continue to seek more flexibility from the federal government in their efforts to design and
implement Medicaid programs. Chairman Paul Ryan, in his Path to Prosperity reform proposals,
calls for less government oversight of Medicaid and modifying it into a block grant program.44
Echoing Chairman Ryan’s proposal, the Republican Governor’s Association (RGA) developed a
policy document linking the flexibility in managing Medicaid to “each state’s needs and
culture.”45 President Obama’s plan does encourage flexibility—but with a different end goal. The
President’s plan envisions a system of flexibility that creates more consistency in the oversight of

!
the federal-state partnership, while permitting states to identify appropriate benchmarks for the
new eligibility rules under the ACA.46
The Government Accountability Office (GAO) found that the inconsistently oversees state
managed care rates and the challenges that exist in ensuring the program’s integrity.47 In some
respects the federal government may be failing to overseer a variety of Medicaid aspects. But if
states were to receive increased flexibility and oversight responsibility, what would they do with
it? The RGA laid out various policy options, giving states increased control over the direction of
the program while limiting the federal government to partially funding and supporting states.48
The Bush Administration implemented the Deficit Reduction Act of 2005 (DRA), giving states
more flexibility to design their Medicaid program. The DRA gave states the option to require
beneficiaries to share Medicaid costs, open Health Opportunity Accounts, to permit beneficiaries
to pay for medical services, and to require a benchmark services package.49 Research indicates
that states did not taken full advantage of the freedom allowed under the Act.50 Due to the nature
of the national economy and its impact on many states, cost-sharing beneficiaries should become
a more attractive option due to flexibility under Medicaid and potential cost savings.
Championed by Paul Ryan, one of the most popular “flexibility proposals is to transition
Medicaid into a block grant program.51 Block grants provide state funding on a fixed dollar
amount, instead of a fixed share amount. The Congressional Budget Office (CBO) reported that
certain aspects of the proposal would shift the cost burden to the states.52 The CBO further stated
that given “the magnitude of the reduction in federal Medicaid spending under the
proposal…states would face significant challenges in achieving sufficient cost savings through
efficiencies to mitigate the loss of federal funding.”53 As a result of the reduced funding, a block
grant plan would force states to make difficult choices when cutting parts of Medicaid.
Furthermore, a block grant program would be sensitive to recessionary factors. The federal
government may provide a variable amount of funds during weak economic times. Uncertain
funding levels may not be sufficient to close state funding. Furthermore, the CBPP criticizes the
block grant proposal for not considering the existing realities within the health care system, such
as increasing costs of pharmaceutical drugs, medical technology, and other health care
advances.54
While permitting states increased flexibility and oversight in design of their respective Medicaid
programs, the block grant proposal is considered to be a weak proposal. Although it accounts for
savings by the federal government, it fails to consider the burden the states may face due to
reduced Medicaid funding. States will be forced to make choices within their Medicaid programs

!
about eligibility, which could lead to a greater number of uninsured. Some states may provide
vouchers for private health insurance to those who no longer qualify for Medicaid. Cost shifting
by the federal government not only becomes a problem for the states, but also for individuals who
must find health care coverage from other sources. Other sources may not have the administrative
structure in place to provide the support for vulnerable patient populations.
Amend Modified Adjusted Gross Income (MAGI) to Include Social Security Benefits
President Obama’s proposal suggests that eligibility for tax credits and reductions for cost sharing
in Medicaid and CHIP will be determined by the newly defined modified adjusted gross income
(MAGI) under the ACA. The new definition of MAGI will include all Social Security benefits,
instead of only the taxable portion. According to the Office of Management and Budget, this
proposal is expected to save $14.6 billion over ten years.55
The major concern is that this change will cause people to lose Medicaid eligibility and become
uninsured.56 But the proposal assumes that those losing Medicaid eligibility will simply shift into
the health care exchanges established by the ACA and receive premium credits, or shift into
employer-based insurance (if this option were available).57 A CRS report noted that the new
definition of MAGI would reduce the number of individuals eligible for Medicaid.58
No research exists about the impact of modifying the MAGI calculation for Medicaid eligibility.
Based on the available information, the best projection of modified MAGI calculations can be
seen in the health care exchanges. Vouchers or credits will be provided to those who no longer
qualify, but private insurance premiums are often more expensive than public insurance. Even
though a significant number of existing beneficiaries may become uninsured, premium vouchers
may cause that number to increase. Premium vouchers do not supplement the cost of private
insurance to the financial satisfaction of former beneficiaries and their families. When the full
ACA is implemented, monitoring how new MAGI definitions affect Medicaid recipients will be
imperative.
Reduce Disproportionate Share Hospital (DSH) Payments
To help cover the cost of uncompensated care, the federal government provides Disproportionate
Share Hospital (DSH) payments to hospitals serving large numbers of low-income and uninsured
patients.59 President Obama’s budget is projected to reduce DSH allotments to the states by $18.1
billion by 2020, with the goal of “aligning future Medicaid supplemental payments to hospitals
with reduced levels of uncompensated care.”60
One of two factors determines the formula used to calculate the funds varies in each state: 1) a
Medicaid inpatient utilization rate in excess of one standard deviation or more above the mean for

all hospitals in the in the state; or 2) a low-income utilization rate exceeding 25 percent.61
Because of the varied ways that states calculate payments, federal funding also varies. These
discrepancies led the HHS Office of Inspector General (HHS OIG) to conclude that the federal
government was overpaying hospitals due to inaccurate calculations by the states.62 If states made
appropriate calculations and included accurate data, payments would be far lower.63 The HHS
OIG suggests that CMS establishes standard calculations for state DSH payments so that annual
costs incurred by the hospitals are appropriately calculated.64
Aaron McKethan et al. also addresses this problem, stating the DSH program has a “lack of
transparency and accountability” at the state level and questioning whether the money is actually
contributing to the care of low-income and uninsured patients.65 In order for reforms to take hold,
changes in Medicaid coverage are necessary, which the ACA requires through modification of the
MAGI calculations. President Obama’s plan considers lowering the amount of DSH payments
due to the expected number of individuals participating in the health care exchanges.66 But more
comprehensive reform might be necessary to ensure a standard calculation across the states so
that the federal government does not exceed its own spending thresholds. For instance, audits of
hospital data could become a requirement, or Congress could set a state floor for DSH spending.67
Overall, the goal of DSH payment reform should be to maintain the integrity of its purpose:
providing care to low-income and uninsured patients. The ACA is expected to expand health care
coverage to millions, but it is not a universal insurance plan. Some will remain uninsured, not by
choice. The implications for patients currently benefitting from DSH payment reform are not
clearly established in the literature. This aspect of reform should be monitored to identify any
weaknesses and the impact on vulnerable patients’ access to adequate medical services.
Place Dual Eligibles under Medicaid Managed Care
There is no consensus as to whether placing dual eligibles (for Medicare and Medicaid)
completely under Medicaid would work effectively. The Simpson-Bowles and Rivlin-Domenici
proposals both presented the idea of placing dual eligibles on Medicaid managed care.68 A recent
report published in Missouri cautioned state administrators against expanding Medicaid to the
disabled and senior population.69 A major concern with the expansion was the willingness of
primary care physicians to accept new Medicaid patients, and the adequate availability of new
providers.70 Such a transition, in the State of Missouri, would cost more than traditional Medicare

fee-for-service. This report cited a Lewin Group research project on the same question, and
noted that Missouri would need to assume some of the risks inherent to a managed care program,
which could result in greater financial problems for the state.72
Other states, however, could have success with shifting their senior population to Medicaid
managed care. The Senate Special Committee on Aging held a hearing on July 18, 2012 entitled
“Examining Medicare and Medicaid Coordination for Dual Eligibles.” Thomas Betlach, the
Director of the Arizona Health Care Cost Containment System (AHCCS), testified about the
success Arizona experienced with Medicaid managed care.73 The model used in Arizona has
private plans go through a competitive bidding process through which beneficiaries can select the
plan most suited to their needs.74 This program, coupled with Missouri, indicates that Medicaid
managed care should not be implemented at the federal level, but rather considered by each state
individually. States have to consider their budgets while securing insurance and health care access
for dual eligibles.
Other research indicates that moving dual eligibles to Medicaid may be feasible, but careful
planning is necessary in order for states to accommodate a population that is among the most
vulnerable and high-risk in the system.75 Oversight also needs to be structured in an appropriate
manner. Additionally, for states facing budget crises that force cuts to other programs, managing
an enlarged Medicaid managed care program may not be feasible. Some see Medicare as the best
place for dual eligibles because the federal government already pays for them.76 Given that the
only care for dual eligibles that Medicaid finances is long-term care, the best solution may be to
improve the services delivered to them through Medicare rather than transfer them to Medicaid.77
Furthermore, Medicaid is a program designed to accommodate a younger population and
therefore lacks experience with the challenges of dual eligibles.78
Conclusion
Medicare and Medicaid are two of the most complex and expensive social program, and account
for a significant percentage of government spending. The debt reform proposals discussed in this
paper offer solutions to decrease federal spending levels while maintaining solvency for future
generations. As states continue to deal with budget shortfalls, Medicaid reform will focus on
decreasing the burden on state government.
Cancer patients have the most to gain or lose from these debt reform proposals. Due to the
complex and expensive nature of oncology treatments, cancer patients need uninterrupted, quality
care. While the specific impact of these debt proposals is unclear, it is critical that for any reform

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effort ensure that vulnerable populations, such as cancer treatments receiving ongoing care, are
granted sufficient protections against diminished access. !
Sarah Thompson Schick is a third-year student at the University of Virginia School of Law where
she is President of the Health Law Association and Managing Editor of the Virginia Journal of
Law and Technology. Prior to law school, Sarah worked in the areas of clinical trials project
management and government contracting. Her interest in Medicare and Medicaid was cultivated
during her previous work experience and while she completed a Masters of Science in Health
Systems Management at George Mason University.

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The Enduring Myths Of Covert Action
Loch K. Johnson
Covert action consists of secret government attempts to influence events overseas through the use
of propaganda, political and economic operations, and paramilitary (war-like) activities. In this
essay, Loch K. Johnson, the Regents Professor of Public and International Affairs at the
University of Georgia punctures fourteen myths that have distorted the public’s understanding of
this hidden approach to American foreign policy. Despite the drawbacks associated with covert
action, the central argument of this essay is that the United States needs this veiled capability for
emergencies, but that it ought to be used in a more discriminating manner.
Covert action is among the most tightly held operational secrets in the United States government.
This fact presents a daunting challenge to researchers, not to mention to democratic theory and its
requirement of an informed citizenry. A sufficient number of government reports, intelligence
memoirs, and interviews with practitioners have surfaced since 1975, however, to provide some
insight into the conduct of America’s secret foreign policy. Yet one must be cautious with this
literature because it is replete with myths, beginning with the basics of definition.1
Myth No. 1: The meaning of covert action is clearly delineated.
The first myth has to do with the false notion that the borders of covert action have been carefully
mapped. With the Intelligence Authorization Act of 1991, the government did (at last) craft a
formal statutory definition of covert action as “an activity or activities of the United States
government to influence political, economic, or military conditions abroad, where it is intended
that the role of the United State Government will not be apparent or acknowledged publicly.” Put
more simply, covert actions consist of secret governmental attempts to influence events overseas
through the use of propaganda, political and economic operations, and paramilitary (war-like)
activities.
The concept of secret influence is spongy, though. A range of diplomatic and military objectives
have seeped into this definition, often blurring the distinction between hidden activities run by the
Central Intelligence Agency (CIA), on the one hand, and by diplomats and the military, on the
other hand. Defenders of the Iran-contra affair in the 1980s argued, for example, that the Reagan
administration’s concealed support for “freedom fighters” in Nicaragua (by way of privately
raised funds) was really a matter of “secret diplomacy,” not covert action. They reasoned that
since the leaders of Nicaragua were aware of the CIA’s involvement in the affair, the operation
could not truly be considered a covert action. Lawmakers, who were kept in the dark about this
scandal until it leaked to the media in 1986, responded that operation’s secrecy, reliance on the
CIA, and goal of influencing events in Iran and Central America made it indisputably a covert
action.2

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1

The debunking of myths that follows here grew out of a brief essay by the author, entitled “The Myths of
America’s Shadow War” and published by The Atlantic.Com (January 2013), 1-5.
2
See William S. Cohen and George J. Mitchell, Men of Zeal (New York: Penguin, 1988).

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Further, the Pentagon has crept into the covert action terrain by disguising its “special operations”
as traditional military activities. One illustration is the military training of foreign covert forces
carried out by U.S. Special Operations Forces (SOF), which sometimes fields soldiers acting out
of uniform and on an unacknowledged basis – precisely the kind of activity engaged in by the
CIA under the rubric of covert action.
By calling such activities (and even assassination operations using drones against terrorists
outside of a battlefield setting) “traditional military operations,” the Pentagon is able to sidestep
the formal legal procedures for reporting to Congress on proposed covert actions.3 As a result of
the Hughes-Ryan Act of 1974, these procedures require presidential endorsement by way of a
signed “finding,” as well as notification to the two congressional Intelligence Committees. In
contrast, all the military brass has to do is claim its soldiers are engaged in a “war against
terrorism” and the Hughes-Ryan requirements melt away. These definitional obfuscations have
allowed diplomats and generals to evade the Hughes-Ryan safeguards established to supervise the
veiled side of foreign policy.
Myth No. 2: Covert action offers a quiet approach to America’s foreign relations.
An appealing aspect of covert action is the promise that the United States may be able to address
vexing problems abroad in a quiet manner, without the target nation or group overseas realizing
that Washington, DC is the silent hand behind the ill-fate that has visited them. Indeed, one of the
euphemisms for covert action inside the U.S. government is “the quiet option.”
Some covert actions fulfill this expectation. Throughout the Cold War, for instance, the CIA
planted propaganda in foreign newspapers and magazines, as well as in radio and TV programs
around the globe – upwards of eighty covert media insertions a day at the height of the Cold War.
Most of these efforts went smoothly, with the U.S. government’s sponsorship undetected.
Nonetheless, even in the realm of secret propaganda, the wheels periodically came off the wagon
in a noisy manner. In the early 1970s, for example, the CIA’s backing of Radio Free Europe and
Radio Liberty leaked to the world. So did the ties of the Agency (as the CIA is known by
insiders) to selected American publishing houses that printed anti-Soviet works for the
government. These revelations called into question the independence of U.S. media outlets and
tarnished America’s reputation for having a “free press.”
Noisier still were various economic and paramilitary covert actions, such as the disastrous attempt
by the CIA to overthrow the Castro regime in 1961 through a “secret” invasion that began and
quickly ended at the Bay of Pigs in Cuba; or the use of mines to blow up shipping in Nicaraguan
harbors two decades later. Nothing quiet about these operations, or the CIA’s paramilitary
ventures in a host of other countries from Southeast Asia in the 1960s and Southwest Asia in the
1980s to the counterterrorism operations of today. Unmanned aerial vehicles (UAVs or drones)
may fly silently, but there is nothing quiet about the explosions made by Hellfire missiles when
they strike targets on the ground.

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Myth No. 3: Covert action presents an attractive alternative to reliance on America’s
diplomats or Marines.
Diplomacy can be maddeningly slow and often ineffectual; and sending in the Marines is about as
noisy as American foreign policy can get. In between is the so-called Third Option – another
euphemism for covert action. Framing foreign policy options in this manner, though, sets up an
inertia inside the government that too often carries the United States toward the use of covert
action, while slighting other options that might merit greater consideration.
Beyond diplomacy, armed force, and covert action is the option of doing nothing – not a bad idea
at times for a nation that has been bruised both physically and fiscally by endless interventions
aboard, overt and covert. Often other nations or regions must, and should, determine their own
destinies, free of superpower meddling. Setting a good example – as by honoring the principles of
a free press, eschewing torture and extraordinary rendition, and providing detainees with the
rights of habeas corpus – can do more to win friends and admiration abroad than scores of
diplomatic negotiations or armed interventions. Economic statecraft offers another promising set
of options, whether through the establishment of trade relations, the use of sanctions, or the
extension of development assistance that reaches into villages from Pakistan to Nigeria with help
in the construction of health clinics, schools, and clean water facilities.
Myth No. 4: Covert actions undergo rigorous government review before they are
implemented.
This myth had limited validity prior to 1975, when covert action approvals frequently consisted
of nothing more than a secure telephone conversation between the director of the CIA and the
national security adviser in the White House. The Church Committee, led by Senator Frank
Church (D, Idaho), discovered in 1975 that only about 14 percent of all covert actions from 1961
to 1975 had been authorized by the National Security Council (NSC).4 The Committee concluded
that these ambiguous arrangements were intentional, designed to protect the president and to blur
accountability – the infamous doctrine of plausible deniability, whereby unelected bureaucrats
decided when and where covert actions would occur, all in the name of keeping the president’s
hands clean.
In 1974, Congress threw this doctrine out the window and, with enactment of the Hughes-Ryan
amendment, required formal presidential approval of covert actions and notification to the
congressional Intelligence Committees. Today, the review of covert action proposals is far more
thorough than during the earlier era of benign neglect. Nonetheless, a rigorous review continues
to remain elusive. One of the chief obstacles has been the presidential use of “generic” or
“worldwide” findings. The word “finding” refers to the president’s formal approval of a covert
action; the president must “find” that a certain covert action is important and warrants his
approval. The expectation on Capitol Hill is that a finding will be accompanied by a fulsome and
specific accounting of the proposed operation, so that lawmakers can evaluate its appropriateness.
With generic or worldwide findings, specificity is abandoned; the wording of a presidential
approval becomes an open-ended opportunity to engage in covert action, as the CIA defines it.

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The finding might provide the Agency with authority “to fight global terrorism.” This broad
language could be interpreted to mean almost anything, with carte blanche to carry out operations
anywhere, anytime. In contrast, a more accountable finding would say something like this: the
CIA has authority “to engage in clandestine radio broadcasts from Afghanistan, transmitted
throughout northwestern Pakistan for the next six months.” Here are the details (ideally
accompanied by cost and risk estimates) that would allow proper oversight by lawmakers.
The benchmark of rigorous review frequently collapses, too, at the time when Congress is
notified about a covert action approval. This notification takes place via separate briefings to both
the House and Senate Intelligence Committees. Often the intelligence briefers (the CIA director
or a designee) try to slip by with thin explanations when appearing before the Committees in
closed session. Lawmakers present at the briefings must flesh out the details through questioning;
sometimes they perform this important duty and sometimes they don’t.
Timing is important, as well. Hughes-Ryan originally provided for ex post facto reporting to
lawmakers on a finding. “In a timely manner,” was the prescription, which was interpreted by
Congress to mean within a day. In 1980, the Intelligence Oversight Act upped the ante-to-ante
facto reporting – before the covert action went into effect. This was a powerful form of review
adopted by lawmakers, although the provision included a temporary escape hatch: in emergency
situations, the CIA director could limit advanced reporting to only eight leaders of Congress (“the
Gang of Eight” – four leaders of the Intelligence Committees and the four top leaders in the
House and the Senate). Within a day, however, the CIA was required to follow-up with a briefing
to the full membership on each of the Intelligence Committees. Yet since 1980, presidents have
sometimes chosen to report only to the Gang of Eight; or, worse, only to a Gang of Four
lawmakers. And, sometimes, to a Gang of Zero. During the Iran-contra scandal targeted at
Nicaragua, for example, the Congress received no reports whatsoever about this most notorious
of all the CIA’s covert actions.
Myth No. 5: The approval and review process for covert action is excessively cumbersome
and harmful to the nation’s need for quick responses to challenges overseas.
Some intelligence officials long for the good old days before the Church Committee, HughesRyan, and subsequent laws related to covert action made life more complicated for the CIA.
Better the simple telephone call to the national security adviser than the hurdles posed by findings
and congressional notifications. The end result of this congressional “micromanagement,”
according to this nostalgic view, is to slow down the Agency in the conduct of its important
obligation to thwart dangers from abroad. “What we need is horsepower, not brakes!” an
exasperated senior CIA officer said to me soon after the Church Committee recommended tighter
supervision of the Agency in 1976.
In fact, though, the Hughes-Ryan procedures can move with alacrity when necessary, thanks to a
link-up of secure telephones that allows quick communication among the CIA director, the
president, and other key players responsible for discussing and green-lighting a covert action. The
briefings to Congress can be expedited, as well, through the Gang of Eight provision, which
allows for rapid action during times of crises. The advantages of the Hughes-Ryan procedures
and their “democratization” of covert action greatly outweigh the only slightly faster informal
methods of earlier days. Appropriately, the pernicious doctrine of plausible deniability has been

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discarded, replaced by a clear paper trail of responsibility leading directly to the Oval Office.
Such accountability is vital to democracy. During the Iran-contra affair, the national security
adviser told investigators that he had bypassed Congress because he “didn’t want any outside
interference.”5 According to the Constitution, however, Congress is part of the government –
indeed, it serves (along with the media) as a vital check on executive branch power. Hughes-Ryan
brought other elected representatives into the covert-action decision loop: lawmakers on the
Intelligence Committees, not just the president. This legislative measure introduced at least a
modicum of democracy into the dark side of American government, providing a safeguard against
wrong-minded decisions by the executive branch.
Those who place a premium strictly on efficiency may rue the development of a wider circle of
accountability for intelligence activities; but, those wary of power and its potential abuse – that is,
anyone who has studied history – will view the added precaution of the findings process as a
prudential extension of democratic governance.
Myth No. 6: The U.S. government closely monitors covert actions as they are implemented.
This myth is particularly risible for covert actions carried out under the rubric of a generic
finding. When overseers are unclear about the scope of a covert action in the first place, they are
unable to track its path during the implementation phase. Even when a finding is specific, the
challenges of maintaining accountability in the field are considerable. Clark Clifford, an adviser
to Presidents Truman and Johnson, told the Church Committee:
“I believe on a number of occasions, a plan for covert action has been presented
to the NSC and authority is requested for the CIA to proceed from point A to
point B. The authority will be given and the action will be launched. When point
B is reached, the persons in charge feel it is necessary to go to point C, and they
assume that the original authorization gives them such a right From point C,
they go to D and possibly E, and even further.”6
Clifford’s testimony underscores the importance of specific findings with little fudge room. In
addition, intelligence managers down the chain-of-command must strike the right balance
between providing flexibility in the field, on the one hand, with adherence to the intentions of the
original finding, on the other hand. A covert action manager in Afghanistan has written: “... the
[CIA’s covert action] teams often could respond more quickly and effectively [in Afghanistan in
recent years], sometimes before we in HQS even knew what action they were taking. This was
more than OK – it was what I wanted. The field leaders demonstrated flat, networked intelligence
collaboration and covert action at its best.”7 While it is important to avoid the stifling of initiative
in the field, if carried too far, this philosophy of management can lead to some CIA officers
carrying their “authority” too far.
Probably no one in the Kennedy White House would have dreamed the CIA would hire the Mafia
to help with its assassination plans against Fidel Castro. And who would have surmised that CIA

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Director William J. Casey would involve elements of the Agency in the illegal Iran-contra
activities? Especially troubling of late is the CIA’s recruitment of private companies to carry out
intelligence operations overseas. Here the chain-of-command and the lines of accountability are
notably vague; and the actors are less likely to be socialized into the relatively new norms of
intelligence-under-the-law, as required by reforms in the post-Church Committee era. To guard
against CIA rogue behavior, lawmakers on the Intelligence Committees and their staff have an
obligation to stay on top of covert actions as they unfold, not just when they are approved and
reported to lawmakers in Washington at the findings stage.
Myth No. 7: Covert action has the virtue of allowing the United States to act alone in
foreign affairs.
Diplomacy and the use of military force normally involve many countries. In the case of global
environmental treaties, well over a hundred nations now gather periodically for negotiations. The
recent wars in Iraq and Afghanistan, though mainly U.S. initiatives, have included dozens of
nations operating as an anti-terrorist coalition (many induced to participate by assurances of U.S.
foreign aid in exchange). These are major enterprises that require enormous amounts of funding,
diplomatic skill, and investments of time. In contrast, covert action seems to offer an opportunity
for unilateral action: the United States moving with secrecy, dispatch, and no extra weight.
In reality, covert actions of any consequence – particularly paramilitary operations – turn out to
be complex undertakings. The CIA’s covert wars in Laos from 1962-1968 and against the Soviet
military in Afghanistan during the 1980s swallowed large amounts of financial resources and
preoccupied the Agency for years. Nor can the United States operate alone in covert ventures of
any scope. Indeed, a fundamental tenant of success in this domain is the need to have a competent
ally inside the target nation. In Laos, the ally was the Hmung tribesmen, fierce anti-communist
warriors; in Afghanistan during the 1980s, the ally was the anticommunist mujahideen (who
unfortunately grew into the Taliban regime that provided a safe haven for Osama bin Laden and
the Al Qaeda terrorist organization). One of the most successful U.S. covert actions was the
routing of the Taliban and Al Qaeda from Afghanistan in the aftermath of the 9/11 attacks. A sine
qua non for this victory was the internal assistance of the Northern Alliance, a tribe of Afghans
who also opposed the Taliban. Covert actions of any scale do not occur in a vacuum; they can
have many moving parts and are rarely a quick and easy solution – the beguiling come-on of
secrecy notwithstanding.
Myth No. 8: Covert action offers an inexpensive fix to foreign policy dilemmas.
Another misconception about covert action is that it is inexpensive. Of course, practically any
approach to America’s recent woes in Iraq and Afghanistan would have been cheaper than the $2to-3 trillion price tag the U.S. taxpayers will have paid for these overt military interventions when
all the dust settles. Sometimes costly overt wars are unavoidable, as the brutal actions of the Axis
powers properly persuaded the United States in 1941. Nevertheless, it would be wrong to assume
that covert actions are always a cheap date.
True, some small-scale operations are reasonably priced. The fee for placing a U.S. propaganda
article into a foreign newspaper through a recruited media asset is low (but limited in impact as
well). Large-scale political, economic, and paramilitary operations, however, can run into

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millions of dollars – even billions when toting up the costs of covert interventions in such places
as Korea and Vietnam (1950-1953 and 1965-1973, respectively, in harness with America’s
military intervention); Nicaragua and Afghanistan (the 1980s); and, most recently, Iraq and
Afghanistan (as complements to the overt U.S. wars in these nations). When President Truman
established the CIA in 1947, covert action was merely the tail on the dog – and not even
mentioned in the founding National Security Act of that year. Since then, the tail has frequently
wagged the dog and the cash register for covert action keeps ringing.
Myth No. 9: Covert action is resorted to only in extreme circumstances that threaten the
United States.
The significant expenses of covert action would be more tolerable if this approach were limited to
operations designed to protect the United States from parlous circumstances; but the record shows
that Washington officials have resorted to this secret approach far beneath that standard.
Frequently the targets have been small, weak countries. For example, during the Cold War,
America’s nemesis was the Soviet Union and its satellite states in Eastern Europe. Yet few covert
actions were directed against this empire, outside of efforts to infiltrate pro-Western propaganda
behind the Iron Curtain. Instead, any developing nation that had the temerity to ally or even flirt
with the USSR became a target, however remote the chances these locations truly represented a
genuine threat to the United States. Chile is a well-known example, with its democratically
elected government led by President Allende targeted by the Nixon administration for a coup
d’etat during the 1970s.
As historian Michael Grow has written with respect to CIA interventions in Latin America, “Cold
War presidents and their senior advisers believed that a passive U.S. response to Marxist or
otherwise unfriendly regimes in the Western Hemisphere would create a perception of U.S.
weakness in the eyes of the international community, with potentially serious long-range
consequences for the nation’s security.”8 The guiding philosophy became as simple as ABC:
Anybody But Communists. Yet most of these countries were driven by a deep sense of
nationalism, not communism (although some accepted foreign aid from Moscow when turned
down by the United States). One can only wonder how much more successful other options
would have been in winning over nations in the developing world, such as foreign aid, trade
inducements, student and cultural exchanges, and patient diplomacy conducted with a hearing aid
rather than a bullhorn.
Myth No. 10: Covert action is driven by the imperatives of U.S. security, rather than
bureaucratic politics.
The reality is that covert action can be strongly influenced by the personal agendas of ambitious
bureaucrats, not just the security interests of the United States. The classic case is Richard M.
Bissell, Jr., a senior official during the 1960s in the Directorate of Operations, home of the CIA’s
Covert Action Staff (CAS) during the Cold War. (The Directorate of Operations has since been
renamed the National Clandestine Service.) According to Peter Wyden’s exhaustive study of the
Bay of Pigs fiasco, Bissell pushed this covert action on John F. Kennedy in hopes of impressing

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8

Michael Grow, U.S. Presidents and Latin American Interventions (Lawrence: University Press of Kansas,
2008), 187.

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the President by removing the Castro regime – a persistent irritant to the administration.9 The
payoff to Bissell (or so he hoped): promotion to CIA director. Never mind that the Cuban analysts
at the Agency considered the proposal doomed to failure from the start.
The Covert Action Staff is brimming with professional intelligence officers with grandiose
schemes about how their tradecraft can transform the world and, at the same time, accelerate their
own careers. As revealed by the Church Committee, some of these ideas have been madcap, from
an exploding cigar for Castro’s consumption to “Operation Elimination by Illumination,” also
aimed at Cuba.10 In this plan, U.S. submarines would surface off the island’s coastline, firing star
shells into the midnight sky. The CIA’s assets in Havana and the countryside would
simultaneously spread the word that “Christ has come! Rise up against the anti-Christ!” This
Second Coming would supposedly lead to the overthrow of Castro, the anti-Christ. President
Kennedy’s aides, no doubt shaking their heads and wondering what people were smoking at CIA
Headquarters, halted this initiative before its launch date.
Myth No. 11: Covert action can be implemented in a surgical manner.
Another one of the fantasies about covert action is that it can be used with high precision, as a
surgeon would wield a scalpel. A problem overseas? Send in the Covert Action Staff and the
problem will be handled without a trace of evidence implicating the United States. Fed up with
the leader of Iran in 1953? Send in the CIA (this time working with Britain’s MI6) and replace
him with a more reliable puppet – the Shah. This particular operation did proceed with surprising
smoothness, at least over the short run. Over the longer run, the Shah proved highly unpopular
with his own people and was thrown out of office, replaced by religious mullahs hateful toward
the United States then and ever since. Many other operations have been anything but precise or
contained, even over the short run.
Covert propaganda, for instance, presents the problem of “blow back” – an intelligence term
referring to the risk that stories planted overseas by the CIA may be inadvertently reported back
to the United States, say, by a New York Times correspondent in a foreign capital who is unaware
that a local newspaper article has been placed there by an Agency asset. The Times reporter
incorporates elements of this piece in his own dispatch and, in this manner, the American people
become the victims of U.S. government propaganda. Using the phrase blow back more generally,
some observers have argued that covert actions can have a still broader negative effect on
America’s standing in the world. The CIA’s assassination plots against Castro and Lumumba, for
example, stained the nation’s reputation for behaving better than the Soviet KGB, rather than like
this communist intelligence organization widely known for its brutality. The efforts to overthrow
Allende raised further questions about America’s apparent willingness to attack fellow
democracies, not just authoritarian and totalitarian regimes.
Current day assassination operations against suspected terrorists, carried out by the CIA and the
Pentagon using Predators and other drones armed with missiles, are viewed by Washington
officials as a covert action tool that, if not surgically precise, is at least far less likely to injure or

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kill civilians than an open military invasion. Though a valid consideration, this comparison fails
to negate the fact that many civilians have been accidentally killed by U.S. drone attacks.11 There
is nothing surgically precise about current drone policy, which elides such fundamental questions
as where (on what battlefields) the drones may legitimately operate, the criteria for selecting
individuals for inclusion on the hit list, or how proper accountability will be maintained – all the
way from target selection through the pulling of the trigger (by distant remote control) on the
Hellfire missiles.
On the matter of accountability, President Obama conceded on Jon Stewart’s “The Daily Show”
in October of 2012 that “one of the things we’ve got to do is put a legal architecture in place –
and we need congressional help in order to do that – to make sure that not only am I reined in, but
any president is reigned in.” The President’s top counterterrorism adviser, John O. Brennan (now
CIA director), said publically during his Senate confirmation hearings in February of 2013 that
great care goes into the use of drones. Nonetheless, it remains unclear whether each targeted
individual requires a presidential finding, or if a generic finding allows wide discretion to the CIA
and the Pentagon in the targeting of suspected terrorists. Even the rules for the targeting of known
Americans abroad are murky, leading many legal authorities to call for the establishment of a
special review court of jurists to decide on the merits of a presidential request to kill a U.S. citizen
– judicial accountability brought into the process, just as it was for national security wiretaps in
1978 with the Foreign Intelligence Surveillance Act (FISA).
Troubling, too, is a new category of targets, so-called signature strikes: individuals who have not
been specifically identified as terrorists, but who may be found in an area—say, northwestern
Pakistan – that suggests they could be bad actors. Killing people without knowing who they are,
or what they have done or intend to do, may harm the United States and its allies. In any case, it is
a far departure from the use of covert action as a scalpel.
Myth No. 12: The likely outcomes of covert action can be accurately calibrated.
As former Secretary of State Dean Rusk often reminded me when we were colleagues at the
University of Georgia, “Providence has not provided mankind with the capacity to pierce the fog
of the future.” Covert action planners are chiefly guessing what the outcomes of their endeavors
will be, especially years down the road. The Shah may have looked like a good alternative for
Iran (or, more accurately, for the United States and the United Kingdom) in 1953. Glancing back,
former CIA Director William E. Colby offered this evaluation when interviewed by television
host Larry King on February 2, 1987: “The assistance to the Shah…was an extremely good move
which gave Iran twenty-five years of progress before he was overthrown. Twenty-five years is no
small thing.” Neither, he might have added, was a pro-Western leader in the Middle East who
provided a quarter-century of low prices for Americans at their gas pumps. Yet the identification
of the United States with the Shah, whose secret police (Savak) tortured dissenters, has had a
long-term negative effect, beginning with the Revolution of 1979 that overthrew the Shah and
installed a fundamentalist religious regime.
The CIA coup in Guatemala in 1954 may have looked sensible, too, at the time – especially to the
United Fruit Company, which feared that the existing regime might expropriate its holdings or

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charge more at the source for the marketing of bananas in the United States. The profit margin of
the United Fruit Company aside, journalist Anthony Lewis reported that the CIA coup began “a
long national descent into savagery” for Nicaragua that lasted over thirty years.12
The CIA also guided a large-scale paramilitary operation in Laos during the 1960s. The shortterm results were impressive, as the Agency helped the Hmung (or Meo) tribesmen in the north
resist a takeover by the North Vietnamese and their local puppets, the Pathet Lao. The fighting
kept the communists at bay for eight years (1962-1968) in Laos; but, when the CIA departed, the
Hmung eventually found themselves (as CIA Director Colby summed up in his memoir) “in
exile, dead, or living under oppression.”13
When the CIA helped the mujahideen drive out the Soviets from Afghanistan in the 1980s (by
providing them with still-unaccounted-for Stinger missiles, among other forms of aid), the
resulting retreat of the Soviet Army catapulted this operation to a place high on the Agency’s list
of successful covert actions. At least over the short run. Over the longer run, Afghanistan fell into
the hands of Taliban fundamentalists, whom the United States has been fighting since 2001 in
America’s longest war.
The CIA’s assassination plots during the Cold War also raise the question of potential value
gained. Would the killing of Fidel Castro have changed much in Cuba? His brother, Raúl, would
have replaced him (as he eventually did when Fidel grew too old to govern) and, at the time of the
plots, the brother was equally truculent toward the United States. Or did the question of whether
Patrice Lumumba of the Congo lived or died matter that much to the course of the Cold War –
enough for the United States to plan his murder? Unlikely. Moreover, doesn’t the use of
assassination against foreign leaders invite other nations to retaliate in kind, with elected officials
in the United States and other open societies much more vulnerable than dictators in their armed
fortresses? Here is a Pandora’s box best left closed.
Myth No. 13: Covert action is kept within the boundaries of moral acceptability.
Each of these myths raises important ethical considerations. Some covert actions have undeniably
assisted the cause of freedom around the world. For example, the combined CIA-Navy Seal
operation that resulted in the death of Osama bin Laden in 2011 brought a form of justice to the
chief sponsor of the 9/11 attacks and further signaled to other terrorists that their foul deeds
would be avenged. Further, during the Cold War, efforts by the CIA to provide information about
the free world to those trapped behind the Iron Curtain brought some hope to the suppressed
citizens of the Soviet bloc. Moreover, the CIA’s assistance to the Christian Democratic Party in
Italy during the 1960s, in its political struggles against the Italian Communist Party, did much to
keep that nation free and an important partner in NATO. At the same time, though, many of
America’s covert actions have fallen on the down side of any moral evaluation.
For one thing, the CIA has often abandoned covert action partners in the field, leaving them to an
unhappy fate against muscular opponents – like starting a fight in a crowded barroom, then

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ducking out the back door. Among those deserted during the Cold War (from a much longer list)
were the Bay of Pigs invaders, the Hmung of Laos, the Khambas in Tibet, and the Nationalist
Chinese in Burma – all, in the words of critic Ferdinand Mount in the National Review, “so many
causes and peoples briefly taken up by the CIA and then tossed aside like broken toys…”14
In addition, the assassination plots during the Cold War made the CIA like its chief nemesis, the
Soviet KGB. When the Agency established a “Health Alteration Committee” to concoct ways for
eliminating disagreeable leaders abroad; when government scientists crafted a poison dart gun (a
“non-discernable micro-bio-inoculator,” in spytalk) and special ballpoint pens that dispensed
deadly shellfish toxins; when CIA operatives entered into an alliance with Mafia hitmen, the
United States lost sight of its traditional values of honor and fair play.
More recently, the Agency’s drone program has precipitated widespread ethical concern. Reports
from Southwest Asia indicate that even pro-Americans in Pakistan (and there are many) question
the violation of their nation’s airspace by drone attacks.15 Pakistani-Americans whom I meet at
academic conferences and as students in my university classes uniformly question the morality
and legality of these flights and view them as the No. 1 impediment to better relations between
the two countries.
One can only wonder with increased anxiety about the future of drone warfare advanced by
America’s covert-action planners. Over forty nations now have drones. Here is a domain of
shadow warfare begging for the establishment of tighter legal restrictions through an international
treaty. In the not-too-distant future lurks the challenge of non-state actors who will certainly
attempt to acquire this technology, perhaps arming these silent airplanes with weapons of mass
destruction.
During the Cold War, U.S. diplomat George Ball rejected the use of extreme covert action.16
“When we mine harbors in Nicaragua, we fuzz the difference between ourselves and the Soviet
Union,” he said. “We act out of character, which no great power can do without diminishing
itself...When we...fight the Russian’s on their own terms and in their own gutter, we make a
major mistake and throw away one of our great assets.” Harvard University law professor, Roger
Fisher, shared these moral qualms. “When we choose our weapons, let’s choose ones we are good
at using – like the Marshall Plan – not ones we are bad at – like the Bay of Pigs,” he advised. “To
join some adversaries in the grotesque world of poison dart-guns and covert operations is to give
up the most power weapons we have: idealism, morality, due process of law, and belief in the
freedoms of others to disagree, including the right of other countries to disagree with ours.”17
Today, we must – and we can – fight terrorism without becoming viewed as terrorists ourselves
by people around the world.

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Myth No. 14: If the veils of secrecy could be lifted, the public would find that covert action
works to resolve America’s problems abroad.
Many of these reservations about covert action (some would say all) could be dismissed if this
approach to U.S. foreign policy delivered the goods, that is, if it consistently succeeded in
protecting and advancing America’s interests in the world. The historical record indicates,
however, that this is not the case. The argument that all the really good covert actions remain
classified and sealed inside CIA vaults is simply false. Several government investigations have
looked into covert action in recent years and the American people know at least the broad outlines
about most all of them.
The vast majority of covert actions since the creation of the CIA have been modest in nature,
even trivial. More ambitious efforts, such as the Bay of Pigs, have proved unlikely to succeed or
to remain covert. Moreover, as illustrated by the cases of the Shah of Iran and support for the
Afghan mujahideen, the unanticipated consequences of covert action can come back to haunt the
United States. That the United States could have gotten by without the modest covert actions is
plausible; that the nation would have been better off without such failures during the Cold War as
the Bay of Pigs or the dark stain of assassination plots against Third World figures is self-evident.
The covert action record is not without its successes, however. During the Cold War, a helping
hand from the United States to struggling democracies around the world after the World War II –
in harmony with overt economic and political assistance – allowed nations in Western Europe,
Latin America, Africa, Asia, and the Middle East to resist communist aggression. Further, CIA
propaganda that reinforced a commitment to democratic principles probably strengthened the will
of anti-communists around the world. More recently in the aftermath of 9/11, the routing of Al
Qaeda and Taliban forces in Afghanistan registered a covert action high mark. Here was an
outstanding example of the CIA, Pentagon Special Forces, the U.S. Air Force, and local Afghans
in the Northern Alliance working together against terrorists. Also, drone strikes and other smallscale paramilitary operations against Al Qaeda and other terrorist organizations have
demonstrated success, and they may be more acceptable to Americans (and others) than largescale, overt military invasions. These drone covert actions cry out, though, for a warrant process
and prior judicial review of proposed drone targeting against American citizens, as well as closer
monitoring of kill lists by overseers in the executive and legislative branches. Necessary, too, is a
redoubling of efforts to avoid civilian casualties through improve intelligence reconnaissance
before an attack, and the crafting of limits to global drone operations by way a formal
international treaty involving all nations.
Among the hundreds of witnesses who appeared before the Church Committee in 1975, two of
the wisest were Clark Clifford and Cyrus Vance. They had accumulated many years of
experience in the government at the cabinet level. When asked their opinions about covert action,
both embraced a common theme.18 “The guiding criterion,” said Clifford, former secretary of
defense and an author of the National Security Act of 1947, “should be the test as to whether or
not a certain covert project truly affects our national security.” Vance, who would soon become
secretary of state in the Carter administration, told the Committee that “it should be the policy of
the United States to engage in covert action only when they are absolutely essential to the

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national security.” This is central thesis of this essay as well: the United States needs a covert
action capability for emergencies, but must become more discriminating in its use.
After the Cold War, a former CIA Director, William Webster (who had also led the FBI) told the
Aspin-Brown Commission on Intelligence his rule of thumb for deciding on the worthiness of a
covert action proposal.19 He would ask:
•
•
•
•

Is it legal? (That is, in conformity with U.S. laws governing covert action, such as the
Hughes-Ryan findings procedure.)
Is it consistent with American foreign policy, and, if not, why not?
Is it consistent with American values?
If it becomes public, will it make sense to the American people?

The Webster guidelines, couple with the caveats of Clifford and Vance, should be placed on the
office walls of every covert action planner, as well as in the White House and in the suites of the
congressional Intelligence Committees. !
Loch K. Johnson is the Regents Professor of Public and International Affairs at the University of
Georgia. He is the author of over 200 articles; and author or editor of twenty-nine books on
national security, including: National Security Intelligence (Polity, 2012) and The Threat on the
Horizon (Oxford, 2011). He served as assistant to the chairman of the Church Committee (197576) and assistant to Chairman Les Aspin of the Aspin-Brown Commission (1995-96). In 2012, he
was selected as the inaugural “SEC Professor of the Year” for the fourteen universities of the
Southeastern Conference.